Risk Mitigating Behavior in People with Rheumatic Diseases or Psoriasis During the COVID-19 Pandemic Differ by Immunosuppressant Treatment Type: A Patient survey Study

Mark Yates¹, Satveer Mahil¹, Sinead Langan², Claudia De la cruz³, Paola diMeglio¹, Nick Dand¹, Zenas Yiu⁴, Kayleigh Mason⁴, Teresa Tsakok¹, Freya Meynall⁵, Helen McAteer⁶, John Weinman¹, Paolo Gisondi⁷, Luis Puig Sanz⁸, Richard Warren⁴, Francesca Capon¹, Jullien Denis⁹, Tiago Torres¹⁰, Chris Griffiths⁴, Jonathan Barker¹, Kimme Hyrich⁴, Andrew Cope¹, Ian Bruce⁴, Iain McInnes¹¹, Raj Sengupta¹², Helena Marzo-Ortega¹³, Matthew Brown¹, James Galloway¹ and Catherine Smith¹, ¹King's College London, London, United Kingdom, ²London School of Hygiene and Tropical Medicine, London, United Kingdom, ³University of Santiago, Santiago, Chile, ⁴University of Manchester, Manchester, United Kingdom, ⁵Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, ⁶Psoriasis Association, London, United Kingdom, ⁷University of Verona, Verona, Italy, ⁸Hospital de la Santa Creu I Sant Pau, Barcelona, Spain, ⁹Hospices Civils de Lyon, Lyon, France, ¹⁰University of Porto, Porto, Portugal, ¹¹University of Glasgow, Glasgow, United Kingdom, ¹²Royal United Hospitals Bath, Bath, United Kingdom, ¹³University of Leeds, Leeds, United Kingdom

Meeting: ACR Convergence 2020

Date of first publication: October 23, 2020

Keywords: COVID-19, Epidemiology, health behaviors, Late-Breaking 2020

Session Information

Date: Monday, November 9, 2020

Session Title: Late-Breaking Posters

Session Type: Poster Session D

Session Time: 9:00AM-11:00AM

Background/Purpose: Clinician-reported registry data suggest that use of biologics in people with immune-mediated inflammatory diseases (IMIDs) is associated with a lower risk of adverse COVID-19 outcomes compared with no treatment. However, the role of potentially confounding risk-mitigating behaviors is unclear. Given the variation in public health messaging between countries, it is possible that risk mitigating behavior in people with IMIDs will also vary, but this has not been explored to date. We sought to explore risk mitigating behavior using global patient survey data by: (1) determining associations with immunosuppressant treatment type, and (2) characterizing international variation.

Methods: Online surveys were completed by individuals with rheumatic diseases (UK only) and psoriasis (global) between 20th May and 7th September 2020. Data were collected on diagnosis, treatment types, demographics and risk mitigating behaviors. Multiple logistic regression assessed the association between treatment type and the most stringent risk mitigating behavior (‘shielding’, defined as quarantine/staying home/distancing within the home), adjusting for clinical and demographic characteristics. Incomplete covariates were accounted for using multiple imputation in sensitivity analyses. International variations in shielding were assessed in a mixed effects model, adjusted for clinical and demographic differences between nations and accounting for varying sample sizes. Observed and estimated findings were visualized using a caterpillar plot.

Results: Of 3,714 participants from 74 countries, 2,259 (60.8%) reported the most stringent risk mitigating behavior (i.e. shielding). Use of biologics was associated with higher shielding rates compared to no systemic therapy (odds ratio [OR] 1.65, 95% CI 1.32-2.07) and standard systemic therapy (OR 1.37, 95% CI 1.23-1.52). No differences in shielding was found between standard systemic therapies and no therapy. Shielding was also associated with established risk factors for severe COVID-19 (male sex [OR 1.13, 95% CI 1.02-1.25], obesity [OR 1.46, 95% CI 1.32-1.62], comorbidity burden [OR 1.45, 95% CI 1.21-1.75]), rheumatic disease (OR 1.36, 95% CI 1.26 to 1.47) and a positive screen for anxiety or depression (OR 1.58, 95% CI 1.38-1.80). Findings were unchanged following multiple imputation. After accounting for sample size and clinical/demographic differences, modest differences in the mean proportion of patients shielding were observed across different nations.

Conclusion: Higher rates of shielding among people with IMIDs receiving biologics may contribute to the reported lower risk of adverse COVID-19 outcomes. The observed variation in shielding among treatment groups reinforces the need for clear patient communication on risk mitigation strategies. The findings help inform how clinicians discuss COVID-19 risks with vulnerable patients and will inform public health guidelines as the global COVID-19 pandemic continues to unfold.

Figure 1. Multiple logistic regression effect estimates for risk mitigating behavior.

Figure 2. Caterpillar plot of observed and estimated risk mitigating behavior, by nation. The grey markers are the observed national proportions of survey respondents who shielded. The blue markers are the predicted random national effect on shielding from a mixed effects model, with 95% confidence intervals in red. The black horizontal line represents the overall mean.

Disclosure: M. Yates, None; S. Mahil, Abbvie, 2, Celgene, 2, Eli Lilly, 2, Janssen, 2, Novartis, 2, Sanofi, 2, UCB, 2; S. Langan, None; C. De la cruz, AbbVie, Pfizer, Lilly, Janssen, Novartis, Amgen, Boehringer Ingelheim and Sanofi, 2, 8; P. diMeglio, UCB, 2, 8, Novartis, 8, Janssen, 8; N. Dand, None; Z. Yiu, None; K. Mason, Janssen, 8, LEO Pharma, 8, Lilly, 8, Novartis, 8; T. Tsakok, None; F. Meynall, None; H. McAteer, Almirral, Abbvie, Amgen, Celgene, Dermal Laboratories, Eli Lilly, Janssen, LEO Pharma, T and R Derma and UCB, 2; J. Weinman, None; P. Gisondi, None; L. Puig Sanz, Abbvie, 2, 8, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, 2, 8, Janssen, JS BIOCAD, Leo-Pharma, Lilly, Merck-Serono, MSD, Mylan, Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi, and UCB., 2, 8; R. Warren, Abbvie, 2, 8, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Lilly, Leo Pharma, Novartis, Pfizer, Sanofi, UCB Pharma, and Xenoport, 2, 8; F. Capon, Boehringer Ingelheim, 2, 5, AnaptysBio, 2, 5; J. Denis, None; T. Torres, None; C. Griffiths, None; J. Barker, Abbvie, 2, 8, Almirall, 2, 8, Amgen, 2, 8, Boehringer Ingelheim, 2, 8, Bristol Myers Squibb, 2, 8, Celgene, 2, 8, Janssen, 2, 8, LEO Pharma, 2, 8, Lilly, 2, 8, Novartis, 2, 8, Samsung, 2, 8, Sun Pharma, 2, 8; K. Hyrich, BMS and Pfizer, 2, Abbvie, 8; A. Cope, None; I. Bruce, None; I. McInnes, None; R. Sengupta, None; H. Marzo-Ortega, None; M. Brown, None; J. Galloway, UCB, 8, Janssen, 8, Abbvie, 8; C. Smith, AbbVie, GSK, Pfizer, Novartis, Regeneron and Roche, 2, ; PI on consortia with industry partners (PSORT see www.psort.org.uk and BIOMAP https://www.biomap-imi.eu/, 2.

To cite this abstract in AMA style:

Yates M, Mahil S, Langan S, De la cruz C, diMeglio P, Dand N, Yiu Z, Mason K, Tsakok T, Meynall F, McAteer H, Weinman J, Gisondi P, Puig Sanz L, Warren R, Capon F, Denis J, Torres T, Griffiths C, Barker J, Hyrich K, Cope A, Bruce I, McInnes I, Sengupta R, Marzo-Ortega H, Brown M, Galloway J, Smith C. Risk Mitigating Behavior in People with Rheumatic Diseases or Psoriasis During the COVID-19 Pandemic Differ by Immunosuppressant Treatment Type: A Patient survey Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/risk-mitigating-behavior-in-people-with-rheumatic-diseases-or-psoriasis-during-the-covid-19-pandemic-differ-by-immunosuppressant-treatment-type-a-patient-survey-study/. Accessed September 23, 2021.

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