COVID‐19 in Patients With Inflammatory Arthritis: A Prospective Study on the Effects of Comorbidities and Disease‐Modifying Antirheumatic Drugs on Clinical Outcomes

Haberman, Rebecca H.; Castillo, Rochelle; Chen, Alan; Yan, Di; Ramirez, Deborah; Sekar, Vaish; Lesser, Robert L.; Solomon, Gary; Neimann, Andrea L.; Blank, Rebecca B.; Izmirly, Peter; Webster, Dan E.; Ogdie, Alexis; Troxel, Andrea B.; Adhikari, Samrachana; Scher, Jose U.

doi:10.1002/art.41456

Cited by 108 publications

(138 citation statements)

References 34 publications

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“…2,[152][153][154] Multiple studies to date have reported significantly increased risk of serious infections in patients on sGC, with doses as low as 10 mg prednisone-equivalent, although this mostly corresponds to bacterial infections. 28,[155][156][157][158][159][160] Hydroxychloroquine (HCQ) use is recommended in most patients with SLE, owing to multiple health benefits in patients with SLE and overall safety. [161][162][163][164] Various observational studies have indicated a protective effect of HCQ against serious infections in SLE.…”

Section: Commonly Used Drugs In Sle and Predisposition To Viral Infecmentioning

confidence: 99%

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

Fernández-Ruiz

Paredes

Niewold

2021

Translational Research

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As the world navigates the Coronavirus disease 2019 (COVID-19) pandemic, there is a growing need to assess its impact in patients with autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE). Patients with SLE are a unique population when considering the risk of contracting COVID-19 and infection outcomes. The use of systemic glucocorticoids and immunosuppressants, and underlying organ damage from SLE are potential susceptibility factors. Most patients with SLE have evidence of high type I IFN activity, which may theoretically act as an antiviral line of defense or contribute to the development of a deleterious hyperinflammatory response in COVID-19. Other immunopathogenic mechanisms of SLE may overlap with those described in COVID-19, and thus studies in SLE could provide some insight into immune responses occurring in severe cases of the viral infection. We reviewed the literature to date on COVID-19 in patients with SLE and provide an in-depth review of current research in the area, including immune pathway activation, epidemiology, clinical features, outcomes, and the psychosocial impact of the pandemic in those with autoimmune disease.

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Section: Commonly Used Drugs In Sle and Predisposition To Viral Infecmentioning

confidence: 99%

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

Fernández-Ruiz

Paredes

Niewold

2021

Translational Research

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“…There is a concern that patients undergoing immunosuppressive therapy for inflammatory rheumatic and musculoskeletal diseases (iRMD) could be more vulnerable to SARS-CoV-2 infection and hospitalisation than the general population, particularly in those patients with comorbidities such as diabetes, chronic obstructive pulmonary disease, and renal failure. 6 7 Several recent studies in patients with iRMD [8][9][10] and inflammatory bowel diseases (IBD) 11 suggested an increased risk for hospitalisation and severe disease when using glucocorticoids, although no effect on severity or mortality was found with biological diseasemodifying anti-rheumatic drug (DMARD) use. A decreased risk for severe was suggested in such populations with respect to anti-tumour necrosis factor alpha (TNFα) drugs.…”

Section: Autoinflammatory Disordersmentioning

confidence: 99%

Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients

2020

Ann Rheum Dis

170

109

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ObjectivesThere is little known about the impact of SARS-CoV-2 on patients with inflammatory rheumatic and musculoskeletal diseases (iRMD). We examined epidemiological characteristics associated with severe disease, then with death. We also compared mortality between patients hospitalised for COVID-19 with and without iRMD.MethodsIndividuals with suspected iRMD-COVID-19 were included in this French cohort. Logistic regression models adjusted for age and sex were used to estimate adjusted ORs and 95% CIs of severe COVID-19. The most significant clinically relevant factors were analysed by multivariable penalised logistic regression models, using a forward selection method. The death rate of hospitalised patients with iRMD-COVID-19 (moderate–severe) was compared with a subset of patients with non-iRMD-COVID-19 from a French hospital matched for age, sex, and comorbidities.ResultsOf 694 adults, 438 (63%) developed mild (not hospitalised), 169 (24%) moderate (hospitalised out of the intensive care unit (ICU) and 87 (13%) severe (patients in ICU/deceased) disease. In multivariable imputed analyses, the variables associated with severe infection were age (OR=1.08, 95% CI: 1.05–1.10), female gender (OR=0.45, 95% CI: 0.25–0.80), body mass index (OR=1.07, 95% CI: 1.02–1.12), hypertension (OR=1.86, 95% CI: 1.01–3.42), and use of corticosteroids (OR=1.97, 95% CI: 1.09–3.54), mycophenolate mofetil (OR=6.6, 95% CI: 1.47–29.62) and rituximab (OR=4.21, 95% CI: 1.61–10.98). Fifty-eight patients died (8% (total) and 23% (hospitalised)). Compared with 175 matched hospitalised patients with non-iRMD-COVID-19, the OR of mortality associated with hospitalised patients with iRMD-COVID-19 was 1.45 (95% CI: 0.87–2.42) (n=175 each group).ConclusionsIn the French RMD COVID-19 cohort, as already identified in the general population, older age, male gender, obesity, and hypertension were found to be associated with severe COVID-19. Patients with iRMD on corticosteroids, but not methotrexate, or tumour necrosis factor alpha and interleukin-6 inhibitors, should be considered as more likely to develop severe COVID-19. Unlike common comorbidities such as obesity, and cardiovascular or lung diseases, the risk of death is not significantly increased in patients with iRMD.Trial registration numberClinicalTrials.gov Registry (NCT04353609).

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“…Epidemiology use, although not with biologic or targeted synthetic diseasemodifying antirheumatic drugs (DMARDs). [8][9][10] During the initial crisis phase of the pandemic in Boston, Massachusetts (March and April 2020), we performed a comparative cohort study that demonstrated similar odds of hospitalisation and death but threefold higher odds of mechanical ventilation among patients with rheumatic disease versus 104 matched comparators without the rheumatic disease. 11 In this follow-up study, we examine COVID-19 outcomes and temporal trends in an expanded number of systematically identified patients with rheumatic disease and matched comparators 6 months into the ongoing COVID-19 pandemic.…”

Section: What Does This Study Add?mentioning

confidence: 99%

Coronavirus disease 2019 outcomes among patients with rheumatic diseases 6 months into the pandemic

et al. 2020

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ObjectiveIn earlier studies, patients with rheumatic and musculoskeletal disease (RMD) who got infected with COVID-19 had a higher risk of mechanical ventilation than comparators. We sought to determine COVID-19 outcomes among patients with RMD 6 months into the pandemic.MethodsWe conducted a cohort study at Mass General Brigham in Boston, Massachusetts, of patients with RMD matched to up to five comparators by age, sex and COVID-19 diagnosis date (between 30 January 2020 and 16 July 2020) and followed until last encounter or 18 August 2020. COVID-19 outcomes were compared using Cox regression. Risk of mechanical ventilation was compared in an early versus a recent cohort of patients with RMD.ResultsWe identified 143 patients with RMD and with COVID-19 (mean age 60 years; 76% female individuals) and 688 comparators (mean age 59 years; 76% female individuals). There were no significantly higher adjusted risks of hospitalisation (HR: 0.87, 95% CI: 0.68–1.11), intensive care unit admission (HR: 1.27, 95% CI: 0.86–1.86), or mortality (HR: 1.02, 95% CI: 0.53–1.95) in patients with RMD versus comparators. There was a trend towards a higher risk of mechanical ventilation in the RMD cohort versus comparators, although not statistically significant (adjusted HR: 1.51, 95% CI: 0.93–2.44). There was a trend towards improvement in mechanical ventilation risk in the recent versus early RMD cohort (10% vs 19%, adjusted HR: 0.44, 95% CI: 0.17–1.12).ConclusionsPatients with RMD and comparators had similar risks of poor COVID-19 outcomes after adjusting for race, smoking and comorbidities. The higher risk of mechanical ventilation in the early RMD cohort was no longer detected in a recent cohort, suggesting improved management over time.

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COVID‐19 in Patients With Inflammatory Arthritis: A Prospective Study on the Effects of Comorbidities and Disease‐Modifying Antirheumatic Drugs on Clinical Outcomes

Cited by 108 publications

References 34 publications

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients

Coronavirus disease 2019 outcomes among patients with rheumatic diseases 6 months into the pandemic

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