Regular Inhaled Corticosteroids Use May Protect Against Severe COVID-19 Outcome in COPD

Abstract

Purpose

Population-based studies provide conflicting evidence about how inhaled corticosteroids (ICS) impact COVID-19 outcomes among COPD patients. We investigated whether regular ICS exposure affects risk, severity, or survival in SARS-CoV-2 infection, using a nationwide linked Swedish population register database.

Patients and Methods

During January–December 2020, we studied two defined Swedish adult populations – Whole population [≥40 years] (N = 5243479), and COPD subpopulation [≥40 years] (N = 133372), in three study cohorts, respectively: 1. Overall cohort (index date 1 Jan 2020), 2. COVID-19 diagnosed sub-cohort (index date = diagnosis date), and 3. COVID-19 hospitalized sub-cohort (index date = admission date). Regular exposure was defined as ≥3 ICS prescriptions in the year before index. Hazard ratios (HRs) for outcomes (COVID-19 onset, hospitalization, ICU admission, or death) related to ICS exposure were estimated using Cox regression. Confounding was controlled by propensity score methods applying Average Treatment effect in the Treated (ATT) weighting.

Results

Regular ICS use was associated with only very slightly increased onset of COVID-19, hospitalization, ICU admission, and death in the overall whole population cohort and in the overall COPD subpopulation cohort, except for ICU admission (marginally non-significant HRs, up to 1.13); and no clear increase in the diagnosed sub-cohorts. However, in the COVID-19 hospitalized COPD sub-cohort, ICS therapy showed reduced risks against progression to ICU admission and death, significant for death (HR 0.82 95% CI [0.67–0.99]).

Conclusion

For COPD patients, ICS therapy offers some protection against progression to ICU admission and death among COVID-19 hospitalized patients. Our findings alleviate concerns about increased risks of COVID-19 by ICS treatment and provide evidence supporting the continuation of ICS therapy for COPD patients.

Keywords:

• COVID −19
• COPD
• mortality

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

ML has received personal fees from AstraZeneca, Chiesi, GSK, Novartis, Boehringer-Ingelheim and Sanofi. LV has received grants and personal fees from AstraZeneca and personal fees from GSK, Novartis, Boehringer-Ingelheim, Menarini, Resmed, Chiesi, AGA Linde, Zambon and Pulmonx. FN was an employee of AstraZeneca until 2019 and holds some AstraZeneca shares. The authors report no other conflicts of interest in this work.

Additional information

Funding

The SCIFI-PEARL study has basic funding based on grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (grants ALFGBG-938453, ALFGBG-971130, ALFGBG-978954,) and previously from FORMAS (Research Council for Environment, Agricultural Sciences and Spatial Planning), a Swedish Research Council for Sustainable Development (grant 2020-02828). This research was also based on support from the Swedish Heart-Lung Foundation (20210030, 20210581).