Clinical Outcomes of Patients with COVID-19 and Chronic Inflammatory and Autoimmune Rheumatic Diseases: A Multicentric Matched-Cohort Study

Abstract

Background The impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here we compare the outcomes of a cohort of rheumatic patients with a matched control cohort to identify potential risk factors for severe illness. Methods In this comparative cohort study, we identified hospital PCR+ COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or autoimmune/immunomediated diseases (AI/IMID). Non-rheumatic controls were randomly sampled 1:1, and matched by age, sex, and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, ICU admission, or serious complications. We assessed the association between the outcome and potential prognostic variables, adjusted by COVID treatment, using logistic regression. Results The cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 [IQR 53-78] and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and AI/IMID (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular, or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID were increased age (OR 5.31; CI 3.14-8.95), male sex (2.13; CI 1.35-3.36) and having an AI/IMID (OR 1.98; CI 1.15-3.41). Conclusion In patients with chronic inflammatory rheumatic diseases aging, sex and having an AI/IMID but not IA nor previous immunosuppressive therapies were associated with severe COVID-19.

Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial

“…Importantly, immunocompromised patients are at high risk for infectious diseases due to immune dysregulation and treatment regimens. In addition, they may fulfill criteria for prioritization in the context of limited vaccine supply, since COVID-19 severity is associated not only with highly prevalent comorbidities in these patients but also with disease activity [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Moreover, an immunocompromised state was reported to be associated with prolonged SARS-CoV-2 shedding 25 , reduced SARS-CoV-2 virus clearance and enhanced viral genomic evolution 26 , emphasizing the relevance of the vaccine for this group of patients in reducing transmission and preventing the emergence of new variants.…”

Hydroxychloroquine for Pre-Exposure Prophylaxis for Sars-Cov-2

“…A great number of individuals on the exposed cohort were on treatment with corticosteroids, immunosuppressive drugs or biological therapies. There is a controversy in the conclusions of different studies about COVID-19 severity in patients with autoimmune diseases who are on treatment with this kind of drugs [27][28][29][30]. All these facts could make us believe that the results of our trial would show a protective effect from the antimalarial drugs.…”

Hydroxicloroquine for Pre-Exposure Prophylaxis for SARS-COV-2

“…A great number of individuals on the exposed cohort were on treatment with corticosteroids, immunosuppressive drugs or biological therapies. There is a controversy in the conclusions of different studies about COVID-19 severity in patients with autoimmune diseases who are on treatment with this kind of drugs [27][28][29][30] . All these facts could make us believe that the results of our trial would show a protective effect from the antimalarial drugs.…”