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2021 OMIG Abstract
The Impact of Non-Infectious Uveitis and Systemic Corticosteroid Use On
COVID-19 Outcomes
Idara Akpandak1, Claire Miller1, Yuwei Sun1, Benjamin Arnold1,2, Nisha Acharya1,2,3,4
1F.I. Proctor Foundation, University of California, San Francisco; 2Department of Ophthalmology,
University of California, San Francisco; 3Department of Epidemiology and Biostatistics, University of California, San Francisco; 4OptumLabs Visiting Fellow, Eden Prairie, Minnesota
Purpose: To determine if patients with non-infectious uveitis (NIU) are at increased risk for coronavirus 2019 (COVID-19) infection, COVID-19 related hospitalization, and death. Also, to characterize the impact of systemic corticosteroid exposure on COVID-19 infection and severe outcomes in patients with NIU.
Methods: Retrospective cohort study utilizing OptumLabs® Data Warehouse, a de-identified United States claims-based database. Cox proportional hazard models were used to identify unadjusted and adjusted hazard ratios for all covariates for each outcome measure. In the analysis of COVID-19 outcomes among NIU patients stratified by immunosuppressive therapy (IMT) exposure status, models used time-updated covariates for IMT exposure. The average daily dose of prednisone equivalent was included as a continuous variable in the adjusted models.
Results: On unadjusted analysis, patients with NIU had a higher rate of COVID-19 infection (5.7% vs. 4.2%, p<0.001), COVID-19-related hospitalization (1.2% vs. 0.6%, p<0.001) and COVID-19-related death (0.3% vs. 0.1%, p<0.001) compared to the general population. However, in adjusted models, NIU was not associated with a greater risk of COVID-19 infection, hospitalization, or death. Among patients with NIU, systemic corticosteroid exposure was significantly associated with COVID-19 infection in the adjusted model (HR = 2.66; 95% CI: 2.19 – 3.24; p<0.001), as well as COVID-19 related hospitalization (HR = 3.26; 95% CI: 2.46–4.33; p<0.001). Long-term exposure (>= 30 days) to <20 mg of systemic corticosteroid was associated with a two to three-fold risk of hospitalization.
Conclusions: Patients with NIU were significantly more likely to be infected with COVID-19 and experience severe disease outcomes. However, this association was due to the demographics, comorbidities, and medications of patients with NIU, rather than NIU alone. Use of systemic corticosteroids in patients with NIU was significantly associated with COVID-19 infection and hospitalization, with the highest risk of hospitalization associated with long term exposure.
Disclosure: S
Support: Supported by the National Eye Institute and Office of Research on Women’s Health, National Institutes of Health, Bethesda, Maryland (R01 EY028739, PI Acharya) and an OptumLabs Data Warehouse research credit.
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