A study has found greater shielding among people receiving targeted therapies for inflammatory joint and skin disease may contribute to the lower risk of adverse COVID-19 outcomes reported previously.

At the beginning of the COVID-19 pandemic, patients with immune-mediated inflammatory diseases (IMIDs), like rheumatic and musculoskeletal diseases and psoriasis, on targeted systemic immunosuppressive therapy were considered to be at higher risk of severe COVID-19. It was recommended that these people should physically isolate at home and avoid face-to-face interactions – known as shielding.

The Risk mitigating behaviours in people with inflammatory joint and skin disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey study identified that patients receiving targeted systemic therapy were more likely to shield. Therefore, this may contribute to the lower risk of adverse COVID-19 outcomes associated with targeted therapies, compared to no systemic or standard systemic treatments, reported by IMID registries, which to-date have not controlled for the extent of shielding behaviour amongst patients surveyed.

Headshot of Professor Matthew Brown

Professor Matt Brown, Director of the NIHR Guy’s and St Thomas’ BRC and study co-investigator, said: “Our study suggests that whilst previous reports indicate that patients receiving targeted therapies have lower risks of COVID-19 adverse outcomes, this may simply be due to increased shielding behaviour amongst patients receiving those therapies, rather than being a property of the therapies themselves.

“The different shielding behaviours amongst people with IMIDs will be an important consideration when clinicians and patients discuss the COVID-19 risk of treatment options.”

The research team used online survey responses of 3,720 individuals with rheumatic and musculoskeletal diseases or psoriasis across 74 countries, between May and September 2020.

Professor Brown added: “I hope the observed variation in shielding across treatment types, IMIDs and nations will inform future public health recommendations for COVID-19 risk mitigating behaviours.

Dr Mark Yates, Clinical Research Fellow at Centre for Rheumatic Diseases, King’s College London and study co-investigator, commented: “The findings should inform future studies into risk of COVID-19 across people with IMID and treatment types to take risk mitigating behaviours into account.”

Other notable findings of the study include:

  • Established risk factors for severe COVID-19 outcome were associated with shielding, including male sex, obesity and comorbidity burden
  • Increasing age was not associated with shielding behaviour in our dataset
  • An association between shielding and anxiety and depression was identified

The study was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, the NIHR Manchester Biomedical Research Centre, the Psoriasis Association, the National Rheumatoid Arthritis Society, the National Axial Spondyloarthritis Society, BritSpA and Lupus UK.

This study paper is a preprint and has not been peer-reviewed yet, so should not be used to guide clinical practice.

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