Use of systemic corticosteroids linked with worse COVID-19 outcomes

In a new study, approved asthma biologics and systemic corticosteroids were not associated with an increased risk for SARS-CoV-2 infection, but use of systemic corticosteroids was linked with worse COVID-19 outcomes.

“In contrast to other respiratory viruses, which are major cause of acute asthma associations, patients with asthma are not at increased risk of exacerbation when infected with SARS-CoV-2,” Adir Yochai, MD, from the pulmonary division at Lady Davis Carmel Medical Center and faculty of medicine at Technion Institute of Technology, Haifa, Israel, said during a presentation at the virtual European Respiratory Society International Congress. “However, the management of COVID-19 in severe asthmatic patients remains challenging, and it's unclear whether a patient with severe asthma could be at higher risk of worse outcome, at least in part because of safety concerns associated with therapies such as biologics or systemic corticosteroids.”

Researchers evaluated electronic health records of 82,602 adults with asthma in Israel who underwent polymerase chain reaction testing for SARS-CoV-2 between March and December 2020. Yochai and colleagues aimed to assess associations between the use of asthma biologics or systemic corticosteroids and COVID-19 severity and 90-day mortality.

Overall, 8,242 (10.2%) patients tested positive for COVID-19 infection. Of these, 1,358 patients were previously treated with systemic corticosteroids and 50 were using asthma biologic therapy.

The researchers reported no association between the use of biologics or systemic corticosteroids and an increased risk for SARS-CoV-2 infection.

Biologic therapy also was not associated with increased risk for moderate to severe COVID-19 or 90-day all-cause mortality, Yochai said.

When the researchers evaluated systemic corticosteroids use, chronic and recent (within the past 120 days) use was significantly associated with increased risk for moderate to severe COVID-19 and 90-day all-cause mortality. As the number of filled systemic corticosteroid prescriptions increased, so did the risk for COVID-19 severity and mortality, according to Yochai.

Previous studies suggested that low eosinophil count was associated with increased COVID-19 severity; in this study, a significantly lower eosinophil count was not found to be associated with increased severity and mortality, Yochai said.

“Our results emphasize the need for optimized management of asthmatic patients to achieve asthma control and avoid whenever it’s possible the need for chronic or recurrent use of systemic corticosteroids,” Yochai said.