Characteristics, outcomes, and mortality amongst 133,589 patients with prevalent autoimmune diseases diagnosed with, and 48,418 hospitalised for COVID-19: a multinational distributed network cohort analysis

Abstract

ObjectivePatients with autoimmune diseases were advised to shield to avoid COVID-19, but information on their prognosis is lacking. We characterised 30-day outcomes and mortality after hospitalisation with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza.DesignMultinational network cohort studySettingElectronic health records data from Columbia University Irving Medical Center (CUIMC) (NYC, United States [US]), Optum [US], Department of Veterans Affairs (VA) (US), Information System for Research in Primary Care-Hospitalisation Linked Data (SIDIAP-H) (Spain), and claims data from IQVIA Open Claims (US) and Health Insurance and Review Assessment (HIRA) (South Korea).ParticipantsAll patients with prevalent autoimmune diseases, diagnosed and/or hospitalised between January and June 2020 with COVID-19, and similar patients hospitalised with influenza in 2017-2018 were included.Main outcome measures30-day complications during hospitalisation and deathResultsWe studied 133,589 patients diagnosed and 48,418 hospitalised with COVID-19 with prevalent autoimmune diseases. The majority of participants were female (60.5% to 65.9%) and aged ≥50 years. The most prevalent autoimmune conditions were psoriasis (3.5 to 32.5%), rheumatoid arthritis (3.9 to 18.9%), and vasculitis (3.3 to 17.6%). Amongst hospitalised patients, Type 1 diabetes was the most common autoimmune condition (4.8% to 7.5%) in US databases, rheumatoid arthritis in HIRA (18.9%), and psoriasis in SIDIAP-H (26.4%).Compared to 70,660 hospitalised with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2% to 4.3% versus 6.3% to 24.6%).ConclusionsPatients with autoimmune diseases had high rates of respiratory complications and 30-day mortality following a hospitalization with COVID-19. Compared to influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality. Future studies should investigate predictors of poor outcomes in COVID-19 patients with autoimmune diseases.What is already known about this topicPatients with autoimmune conditions may be at increased risk of COVID-19 infection andcomplications.There is a paucity of evidence characterising the outcomes of hospitalised COVID-19 patients with prevalent autoimmune conditions.What this study addsMost people with autoimmune diseases who required hospitalisation for COVID-19 were women, aged 50 years or older, and had substantial previous comorbidities.Patients who were hospitalised with COVID-19 and had prevalent autoimmune diseases had higher prevalence of hypertension, chronic kidney disease, heart disease, and Type 2 diabetes as compared to those with prevalent autoimmune diseases who were diagnosed with COVID-19.A variable proportion of 6% to 25% across data sources died within one month of hospitalisation with COVID-19 and prevalent autoimmune diseases.For people with autoimmune diseases, COVID-19 hospitalisation was associated with worse outcomes and 30-day mortality compared to admission with influenza in the 2017-2018 season.

Incidence and factors related to SARS-CoV-2 infection in a cohort of patients with rheumatoid arthritis from a health service provider in Colombia during the COVID-19 pandemic

“…27,28 The differences in management may be due to the degree of disease activity, the clinical practice guidelines adopted by the institution providing the services, the evolution timepoint, the habits of the prescriber, the prescriber's university education and degree of continuous education, patient comorbidities, the marketing strategies used by the pharmaceutical industry, and the characteristics of each country's health systems. 21,29,30 The incidence of SARS-CoV-2 infection in this cohort was 5.1%, which is consistent with that found in France by Costantino et al, 26 who reported an incidence of 6.9% in patients with chronic inflammatory rheumatic disease, including ankylosing spondylitis, rheumatoid arthritis, and psoriatic arthritis, and with that found in Italy by Zen et al, 6 who described an incidence of 7.2%; in contrast, in the United States, Spain, and Korea, the incidence of SARS-CoV-2 infection was between 3.9% and 18.9% in patients TherapeuTic advances in infectious disease diagnosed with rheumatoid arthritis, 31 and in England, the incidence was 2.5%. 8 These variations can be explained by the different methodological designs used in the studies, such as the patient identification method, the rheumatological diseases that were considered, the duration of follow-up, and the time at which the study was conducted.…”

“…The incidence of SARS-CoV-2 infection in this cohort was 5.1%, which is consistent with that found in France by Costantino et al ., 26 who reported an incidence of 6.9% in patients with chronic inflammatory rheumatic disease, including ankylosing spondylitis, rheumatoid arthritis, and psoriatic arthritis, and with that found in Italy by Zen et al , 6 who described an incidence of 7.2%; in contrast, in the United States, Spain, and Korea, the incidence of SARS-CoV-2 infection was between 3.9% and 18.9% in patients diagnosed with rheumatoid arthritis, 31 and in England, the incidence was 2.5%. 8 These variations can be explained by the different methodological designs used in the studies, such as the patient identification method, the rheumatological diseases that were considered, the duration of follow-up, and the time at which the study was conducted.…”

“… 8 These variations can be explained by the different methodological designs used in the studies, such as the patient identification method, the rheumatological diseases that were considered, the duration of follow-up, and the time at which the study was conducted. 6 , 8 , 26 , 31 …”

Hydroxychloroquine/chloroquine in patients with COVID-19 in Wuhan, China: a retrospective cohort study

“…Lane and colleagues reported that HCQ monotherapy was safe in COVID-19. However, HCQ in addition to azithromycin might result in heart failure and cardiovascular mortality [ 39 ]. Tang et al .…”

Sind SARS-CoV-2-reaktive T‑Zellen bei Patienten unter Anti-CD20-Therapie mit einer beeinträchtigten humoralen Antwort nachweisbar und potenziell protektiv?

“…Neuere Studienergebnisse bei mit RTX behandelten Patienten deuten darauf hin, dass trotz der beeinträchtigten humoralen Antwort nach erfolgter Impfung, eine effektive zelluläre Immunantwort ausgebildet werden kann. Patienten mit entzündlich rheumatischen Erkrankungen sind von COVID-19-Infektionen offenbar etwas stärker betroffen als die Normalbevölkerung [2]. Dies liegt wahrscheinlich zum Teil an der Aktivität der Grunderkrankung [3,4], zum anderen aber auch an den für die Behandlung erforderlichen Medikamenten [5,6].…”