Adverse outcome and severity of COVID ‐19 in patients with autoimmune bullous diseases: A historical cohort study

Abstract

The ongoing COVID‐19 pandemic has raised concerns regarding the outcome of this infection in patients with autoimmune bullous dermatoses (AIBDs) due to effect of drugs used to treat these disorders. This investigation was performed from the onset of the pandemic to June 1, 2021. Patients with AIBDs who contracted COVID‐19 were evaluated. A generalized linear model was employed to find the predictors of severe COVID‐19 among patients with AIBDs. Ninety‐three patients with AIBDs with a mean age of 50.3 years were evaluated. The most COVID‐19 related symptoms were tiredness (76.3%) myalgia (69%), and cough (63.4%). During follow‐up, the rate of hospitalization and death were 45.2% and 4.3%, respectively. Previous comorbidities (β = 0.61) and mean prednisolone dosage above 10 mg/day in the last 3 months ( β = 1.10) significantly increased COVID‐19 severity. Also, vaccination against SARS‐CoV‐2 ( β = −1.50) and each passing month from the last rituximab dose decreased severity ( β = −0.02). Notably, 19.3% of the patients developed AIBD flare‐ups following COVID‐19 infection. Higher prednisone dose and the shorter interval from the last rituximab infusion were determinants of severe COVID‐19. Physicians should assess the risk versus the benefits when prescribing the medications. Moreover, vaccination could successfully attenuate COVID‐19 severity.

COVID-19 and autoimmune bullous diseases: Lessons learned

“…Compared with the general population, this systematic review concluded that patients with AIBDs are basically not at increased risk of severe or fatal COVID-19 [ 6 ]. In the later course of the pandemic, five cohort studies focusing on COVID-19 in AIBD patients were published, which mostly confirmed the results of the systematic review [ [7] , [8] , [9] , [10] , [11] ].…”

“…Moghadam et al described 93 AIBD patients with COVID-19, out of whom 42 (45.2%) were admitted to the hospital, 11 (26.2%) required intensive care, and 4 (4.3%) died [ 11 ].…”

“…Similarly, Özgen et al found no difference in steroid usage and dosage between hospitalized and non-hospitalized COVID-19 patients [ 10 ]. On the other hand, Mahmoudi et al and Moghadam et al showed that a prednisolone dose >10 mg per day increased COVID-19 severity [ 9 , 11 ].…”

“…Conflicting data also exist regarding the use of rituximab, a first-line agent in pemphigus, which have been summarized in a systemic review [ 12 ]. While three studies were suggestive of safety concerns regarding rituximab and COVID-19 in AIBD patients [ 7 , 9 , 11 ], two other studies described opposite findings [ 10 , 13 ], and one study was rather inconclusive [ 14 ]. In more detail, Mahmoudi et al showed that the relative risk of getting COVID-19 and being hospitalized decreased by 38% and 45% with each passing month from the last rituximab infusion, respectively [ 9 ].…”

Autoimmune bullous diseases during COVID-19 pandemic: 2022 update on rituximab and vaccine

“…facilities and 3 (14%) died. Of note, two studies found that COVID-19 infection and hospitalization rates were higher with prednisolone dosages > 10 mg/die(14,29). In parallel,Kridin et al.…”