{"doi":"10.1016/j.xops.2023.100411","title":"Immunosuppressive Medications and COVID-19 Outcomes in Patients with Noninfectious Uveitis in the Era of COVID-19 Vaccinations","abstract":"PurposeTo determine the risk of coronavirus disease 2019 (COVID-19) infection, hospitalization, and death in the era of COVID-19 vaccination among patients with noninfectious uveitis (NIU) taking immunosuppressive therapies.DesignRetrospective cohort study from July 1, 2021 to June 30, 2022 using data from the Optum Labs Data Warehouse (OLDW) de-identified claims database.ParticipantsPatients with a diagnosis of NIU from January 1, 2017 and who had at least one year of continuous enrollment in the OLDW.MethodsIncidence rates (IRs) were calculated for each COVID-19 outcome. Unadjusted and adjusted hazard ratios (HRs) were estimated for each variable and COVID-19 outcome using Cox proportional hazards models with time-updated dichotomous indicators for outpatient immunosuppressive medication exposure. To assess the dose-dependent effect of systemic corticosteroid (SC) exposure, the average daily dose of prednisone over the exposed interval was included in the adjusted models.Main Outcome MeasuresHRs and IRs for COVID-19 infection, hospitalization, and death.ResultsThis study included 62,209 patients with NIU. 12,895 (20.7%) were exposed to SCs during the risk period. IRs were increased when exposed to SCs versus unexposed for all COVID-19 outcomes. IRs were also increased for all COVID-19 outcomes when exposed to SCs without COVID-19 vaccination versus exposed to SCs with ≥1 vaccination. In adjusted models, SCs were associated with increased risk of COVID-19 infection (HR, 3.57; 95% confidence interval (CI), 3.24-3.93; P<0.0001), hospitalization (HR, 2.75; 95% CI, 2.07-3.65; P<0.0001) and death (HR, 2.49; 95% CI 1.29-4.82; P = 0.007). Incremental increases in SC dose were associated with a greater risk for all outcomes. DMARDs were associated with a decreased risk of infection (HR, 0.84; 95% CI, 0.74-0.96; P = 0.01) and tumor necrosis factor-α (TNF-α) inhibitors were associated with an increased risk of infection (HR, 1.18; 95% CI, 1.01-1.39; P = 0.04).ConclusionsSC exposure continues to be associated with greater risk of COVID-19 infection, hospitalization, and death among patients with NIU in an era of widespread COVID-19 vaccination. Unvaccinated individuals who are exposed to immunosuppressive treatments have a greater risk of severe outcomes. COVID-19 vaccination should be strongly encouraged in these patients.","journal":"Ophthalmology Science","year":2023,"id":368741,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8489,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":478361,"name":"Emily Tang","orcid":null,"position":1,"is_corresponding":false},{"id":640300,"name":"Yuwei Sun","orcid":"0000-0001-6053-1821","position":2,"is_corresponding":false},{"id":328639,"name":"Benjamin F. Arnold","orcid":"0000-0001-6105-7295","position":3,"is_corresponding":false},{"id":277532,"name":"Nisha R. Acharya","orcid":"0000-0002-9762-9475","position":4,"is_corresponding":false},{"id":1067121,"name":"Samantha Sechrist","orcid":null,"position":0,"is_corresponding":true}],"reference_count":35,"raw_metadata":null,"created_at":"2026-07-19T01:15:24.517012Z","pmid":"38146526","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}