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. 2021 Oct 18;4(10):e2129639. doi: 10.1001/jamanetworkopen.2021.29639

Figure. Adjusted Odd Ratios (ORs) of COVID-19–Associated Hospitalization or Death Among Patients Receiving Immunomodulatory Treatment Regimens vs Tumor Necrosis Factor Inhibitor (TNFi) Monotherapy.

Figure.

Registry-specific and pooled analyses, with TNFi monotherapy used as the reference category. Pooled estimates were obtained using hierarchical multivariable mixed-effects logistic regression analysis with registry and calendar month random effects nested within country. Pooled sensitivity analysis (n = 5213) excludes patients with a presumptive COVID-19 diagnosis (defined as a diagnosis based on symptoms alone). All ORs were adjusted for age, sex, current smoking, immune-mediated disease activity (remission vs active), important comorbidities (cardiovascular disease, diabetes, hypertension, obstructive lung disease, interstitial or other chronic lung disease, kidney disease, obesity [body mass index ≥30; calculated as weight in kilograms divided by height in meters squared], and cancer), and prednisone-equivalent glucocorticoid dose. The pooled sensitivity analysis was also adjusted for concomitant receipt of leflunomide and oral budesonide. The pooled analysis (N = 6077) was additionally adjusted for concomitant receipt of sulfasalazine. The COVID-19 Global Rheumatology Alliance (GRA) registry-level analysis included 3441 patients and was adjusted for immune-mediated disease diagnosis and concomitant receipt of sulfasalazine, hydroxychloroquine or chloroquine, and leflunomide medications. The Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect) registry-level analysis included 300 patients. The Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) registry-level analysis included 2336 patients and was adjusted for immune-mediated disease diagnosis and concomitant receipt of mesalamine, sulfasalazine, and oral budesonide medications. AZA/6MP indicates azathioprine/6-mercaptopurine; JAKi, Janus kinase inhibitor; and MTX, methotrexate.