Those who were exposed to immunosuppressive medications who were not vaccinated have a greater risk of severe outcomes with COVID-19 exposure. Photo: Michael Trottini, OD, and Candice Tolud, OD. Click image to enlarge.

Noninfectious uveitis comprises a spectrum of ocular inflammatory conditions characterized by intraocular inflammation and may be associated with other autoimmune diseases or can be limited to the eye. If untreated, severe cases can result in irreversible damage and loss of vision. Treatment commonly consists of corticosteroids or other immunosuppressive medications such as disease-modifying anti-rheumatic drugs. Although these therapies are used to control inflammation, they may also increase the risk of infection. Because of this, there has been heightened concern for those who are immunocompromised since the beginning of the COVID-19 pandemic. It is known that vaccination provides protection against COVID-19 infection and severe outcomes, but the impact of immunosuppression in patients who are vaccinated remains unclear.

Researchers from the University of California San Francisco sought to determine whether systemic steroids and other immunosuppressive drugs were associated with an increased risk of severe COVID-19 outcomes in patients with noninfectious uveitis in the era of COVID vaccinations. They found that incidence rates were also increased for all COVID-19 outcomes when exposed to systemic corticosteroids without vaccination vs. those exposed to the treatments with at least one vaccination.

This retrospective cohort study period ranged from July 1, 2021 to June 30, 2022. It included 62,209 patients with noninfectious uveitis, of whom 12,895 (20.7%) were exposed to systemic steroids during the risk period. Record of at least one COVID-19 vaccination was 43.5%, and was similar between the exposed and unexposed group (42.6% vs. 43.7%). Within the overall study cohort, 74.7% had uveitis anatomically classified as anterior uveitis, 23.6% had posterior/panuveitis, 1.4% had intermediate uveitis and 0.20% had unknown or sarcoid-related uveitis that did not have a specified anatomical subtype.

Incidence rates were increased when exposed to systemic corticosteroids vs. unexposed for all COVID outcomes. In the current study, published in Ophthalmology Science, record of at least one COVID vaccination was associated with decreased risk of COVID-19 infection, hospitalization and death in both adjusted and unadjusted models. Additionally, among those who were exposed to systemic corticosteroids and did not have a record of COVID-19 vaccination, the risk for COVID infection, hospitalization and death were increased by twofold, fivefold and nearly threefold, respectively.

“This indicates that COVID-19 vaccination was protective in patients with uveitis against all outcomes and was even protective specifically among those who were exposed to corticosteroids,” the authors wrote in their paper. “This points toward the need to strongly encourage vaccination in patients with uveitis who are on immunosuppressive therapies.”

Nevertheless, they proposed that limiting exposure to systemic corticosteroids and use of alternative therapies may be prudent in patients with noninfectious uveitis, and the potential risk discussed in patient-physician counseling. However, the research team strongly encouraged COVID-19 vaccination in patients taking immunosuppressive therapies.