P1210 Risk of post-acute sequalae of COVID-19 in patients with immune-mediated inflammatory diseases

Background

Evidence suggest that about 10-30% of individuals with COVID-19 develop a chronic condition following the acute phase, now referred to as the post-acute sequalae of COVID-19 (PASC) or long COVID1,2. Dysregulation of the immune system and chronic inflammation, which are among the primary drivers of PASC3, are at the heart of immune-mediated inflammatory disease (IMID) pathology. As PASC still remains underexplored in the IMID population, we aimed to carry out a population-based cohort study to estimate the risk of PASC in patients with IMIDs compared to those without a recorded diagnosis of an IMID.

Methods

We used the Danish national registers to identify all individuals with a recorded positive SARS-CoV-2 test between 01 January 2020 and 01 January 2022. Individuals with IMIDs including Crohn’s disease (CD), ulcerative colitis (UC), hidradenitis suppurativa (HS), rheumatoid arthritis (RA), spondylarthritis (SpA), and psoriasis were identified using ICD-10 codes and medication with indication (only for psoriasis) before 01 January 2020. The IMID and non-IMID groups were matched (1:2) on age, sex, municipality of residence, and calendar period. With the first positive date as index, individuals were followed up until a PASC diagnosis, emigration, death or end of the study period (31 July 2022), whichever is earliest. If an individual from the non-IMID group is diagnosed with an IMID, they are censored. Cox proportional hazard regression was carried out to estimate hazard ratios (HRs) with adjustments for age, sex and Charlson Comorbidity Index in all analyses. Subgroup analysis by vaccination status, hospitalization for COVID-19, IMID medication, IMID group, and SARS-CoV-2 variant were carried out.

Results

We compared 25,889 IMID patients to 51,778 individuals without an IMID for the risk of PASC. The median age was 48 (IQR: 35, 61) and 56% were women. Psoriasis was the largest group constituting 47% of the IMID group. During a median follow-up of 7.7(IQR:7.1-16.3) months, a total of 753 cases of PASC were reported in the entire cohort. The Cox proportional hazard regression showed an increased risk of PASC in the IMID group (HR: 1.51, 95% CI: (1.30-1.74)) compared to the non-IMID group. SpA (HR: 1.91, 95% CI:(1.21-3.01)), RA (HR: 1.72, 95% CI:(1.25-2.37)) and psoriasis (HR: 1.50, 95% CI:(1.21-1.85)) were individually associated with an increased risk of PASC.

Conclusion

This cohort study using nationwide registers showed an increased risk of PASC in individuals with an IMID and in spondylarthritis, rheumatoid arthritis and psoriasis individually. The results underline the need for clinicians to be aware of the chronic impact of early SARS-CoV-2 infection that IMID patients are living with at present.

References

1.Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023 Mar;21(3):133–46.

2.Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021 Mar 22;27(4):601.

3.Ceglarek L, Boyman O. Immune dysregulation in long COVID. Nat Immunol. 2024 Apr;25(4):587–9.