Coronavirus Disease 2019

Update on Coronavirus Disease 2019 Outcomes and Vaccine Efficacy in Patients With Immune-Mediated Inflammatory Disease

Jeffrey A. Sparks; Zachary S. Wallace; Philip C. Robinson


Curr Opin Rheumatol. 2021;33(5):412-418. 

In This Article

Abstract and Introduction


Purpose of Review: Although the literature to date on COVID-19 outcomes in those with immune-mediated inflammatory disease has been largely reassuring there remain many unanswered questions. These include the impact of specific medications on outcomes and the antibody response after COVID-19 vaccination.

Recent Findings: We summarized the current literature related to COVID-19 outcomes in immune-mediated inflammatory diseases in rheumatology, gastroenterology, dermatology, and neurology. Overall, we found either no difference or modest differences in risk for severe COVID-19 for people with immune-mediated diseases compared with the general population. When considering disease-specific factors, glucocorticoid use and underlying immune-mediated disease activity were generally associated with worse outcomes. Specific medications varied in associations: tumor necrosis factor inhibitors generally had lower odds for severe COVID-19 outcomes, whereas rituximab use generally had higher odds for severe outcomes. We also detailed the recent reports of antibody response to COVID-19 vaccination in people with immune-mediated inflammatory diseases.

Summary: Investigations of immune-mediated inflammatory diseases across several organ systems have offered important insight into the COVID-19 disease course. Overall, these studies have provided reassurance to patients and clinicians while also identifying groups who may be at higher risk for poor outcomes.


The novel coronavirus pandemic continues to have a tremendous impact on our daily life, particularly in those with immune-mediated disease. This is because of altered immunity from underlying disease and immunomodulating medications. The impact of the pandemic on outcomes has been described previously but constantly evolving information makes regular updates mandatory.[1–3] International collaborative studies, such as the COVID-19 Global Rheumatology Alliance and SECURE-IBD have efficiently generated timely data that has informed the rheumatology community.[4–9]

There is clear relevance to reviewing immune-mediated diseases across specialities as many therapies are used widely, for example, targeted cytokine inhibitors and B-cell depletion therapies are used across rheumatology, dermatology, gastroenterology and neurology. With increasingly large datasets being collected and randomized controlled trials of many immunosuppressing therapies in coronavirus disease 2019 (COVID-19) being completed, we are building a better picture of both the risks and benefits of immune-mediated therapies.[10] With more time and information, it is becoming clear that the risk factors that apply to the general population like age, sex, and comorbidity are critically important to outcomes in patients with immune-mediated disease. Although there are clearly some therapies that seem to stand out for their increased risk, for example, rituximab, the burden of increased risk can be attributed to risk factors that are widely relevant across all those in the community.[11,12]