Do all patients with rheumatic Diseases have a higher risk of COVID 19? Initial results from the Karnataka Rheumatology Association COVID 19 Cohort Study (KRACC)

Shobha, Vineeta; Kodishala, Chanakya; Haridas, Vikram; Kumar, Sharath; Chebbi, Pramod; Pinto, Benzeeta; Jain, Vikramraj K; Ramaswamy, S.; Prasad, Shyam Baboo; Patil, Abhishek; Rao, Vijay; Yathish, G.C.; Dharmanand, BG; Jois, Ramesh; Kamath, Abhay Taranath; Dharmapalaiah, Chethana; Sangeeta, KN; Janardana, Ramya; Srinivasa, C.; Harshini, AS; Srinivasulu, Nagaraj; Singh, Yogesh Preet; Singhai, Shweta; Mahendranath, KM; Chandrashekara, S

doi:10.4103/injr.injr_261_20

Cited by 9 publications

(7 citation statements)

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“…Glucocorticoids (GC) in moderate dose (7.5–20mg/day) conferred higher risk while other immunomodulators including hydroxychloroquine have no impact. 7 , 8 Similar data is also published from large observational, population-based AIRD cohorts wherein no impact of immunosuppressants was observed for mortality outcome. 9 Apart from glucocorticoid exposure of ≥10 mg/day, none of the DMARDs exposure was associated with higher odds of hospitalisation in the GRA cohort.…”

Section: Introductionsupporting

confidence: 64%

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Comparison of Risk Factors During First and Second Wave of COVID-19 in Patients with Autoimmune Rheumatic Diseases (AIRD): Results from KRACC Subset

Jain,

Shobha,

Kumar

et al. 2023

MJR

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Background: The differential influence and outcome of various risk factors on occurrence of COVID-19 among patients with autoimmune rheumatic diseases (AIRD) during different COVID-19 peaks is underreported. Aim: To assess the impact and outcome of conventional risk factors, immunosuppressants, and comorbidities on the risk of COVID-19 among AIRD patients during the first two COVID-19 peaks. Design: Prospective, non-interventional longitudinal cohort study. Methods: This is a subset of the KRA COVID19 cohort undertaken during the initial wave of COVID-19 (W1) (Apr–Dec2021); and the 2nd-wave (W2) (Jan–Aug2021). Data collected included description of AIRD subsets, treatment characteristics, comorbidities, and COVID-19 occurrence. Risk factors associated with mortality were analysed. The incidence rate was compared with that of the general population in the same geographic region. Results: AIRD patients (n=2969) had a higher incidence of COVID-19 in the W2 (7.1%) than in the W1 (1.7%) as compared to the general population (Government bulletin). Age (p<0.01) and duration of AIRD (p<0.001) influenced COVID-19 occurrence in W2 while major disease subsets and immunosuppressants including glucocorticoids did not. The W2 had lower HCQ usage (Adjusted Odds Ratio [AOR]-0.81) and comorbidities like hypertension (AOR −0.54) and pre-existing lung disease (AOR −0.38;0.19–0.75) compared to W1. Older age (1.11) and coexistent diabetes mellitus (AOR 6.74) were independent risk factors associated with mortality in W2. Conclusions: We report 1.7 times higher occurrence, and no influence of major disease subsets or immunosuppressants including glucocorticoids on COVID-19. Age and diabetes were independent risk factors for mortality.

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Section: Introductionsupporting

confidence: 64%

“…We also compare the observations to data obtained from the same population during the 1 st wave of the COVID-19 pandemic. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Comparison of Risk Factors During First and Second Wave of COVID-19 in Patients with Autoimmune Rheumatic Diseases (AIRD): Results from KRACC Subset

Jain,

Shobha,

Kumar

et al. 2023

MJR

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“…To the best of our knowledge this is the first longitudinal cohort of impact of COVID-19 on any immunocompromised or immunodeficient cohorts from India. Initial results of this cohort were published during the early part of the pandemic [ 43 ]. Strengths of our study are its prospective longitudinal non-interventional design, large sample size from specialist rheumatology centres, inclusion of RT-PCR or RAT confirmed COVID-19 patients and investigator initiated follow-up telecalls.…”

Section: Discussionmentioning

confidence: 99%

A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases

et al. 2022

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Background We conducted this study to identify the influence of prolonged use of hydroxychloroquine (HCQ), glucocorticoids and other immunosuppressants (IS) on occurrence and outcome of COVID-19 in patients with autoimmune rheumatic diseases (AIRDs). Methods This was a prospective, multicenter, non-interventional longitudinal study across 15 specialist rheumatology centers. Consecutive AIRD patients on treatment with immunosuppressants were recruited and followed up longitudinally to assess parameters contributing to development of COVID-19 and its outcome. Results COVID-19 occurred in 314 (3.45%) of 9212 AIRD patients during a median follow up of 177 (IQR 129, 219) days. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19. Glucocorticoids in moderate dose (7.5–20 mg/day) conferred higher risk (RR = 1.72) of infection. Among the IS, Mycophenolate mofetil (MMF), Cyclophosphamide (CYC) and Rituximab (RTX) use was higher in patients with COVID 19. However, the conventional risk factors such as male sex (RR = 1.51), coexistent diabetes mellitus (RR = 1.64), pre-existing lung disease (RR = 2.01) and smoking (RR = 3.32) were the major contributing risk factors for COVID-19. Thirteen patients (4.14%) died, the strongest risk factor being pre-existing lung disease (RR = 6.36, p = 0.01). Incidence (17.5 vs 5.3 per 1 lakh (Karnataka) and 25.3 vs 7.9 per 1 lakh (Kerala)) and case fatality (4.1% vs 1.3% (Karnataka) and 4.3% vs 0.4% (Kerala)) rate of COVID-19 was significantly higher (p < 0.001) compared to the general population of the corresponding geographic region. Conclusions Immunosuppressants have a differential impact on the risk of COVID-19 occurrence in AIRD patients. Older age, males, smokers, hypertensive, diabetic and underlying lung disease contributed to higher risk. The incidence rate and the case fatality rate in AIRD patients is much higher than that in the general population.

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“…A prospective, multicentre, non-interventional longitudinal study involving 14 specialized rheumatological centres across Karnataka and one centre in Kerala, India, was conducted during the 1st wave of COVID-19 pandemic between April and December 2020. 5 , 6 Consecutive patients diagnosed with any of the AIRD and in follow-up with collaborating centres were recruited. Patient’s medical records were accessed for baseline information and disease characteristics.…”

Section: Methodsmentioning

confidence: 99%

Risk factors associated with COVID-19 in systemic lupus erythematosus: Results from a longitudinal prospective cohort

Patil

Shobha

Shenoy

et al. 2023

Lupus

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Introduction Patients with SLE (systemic lupus erythematosus) have a higher risk of infection due to dysregulated immune system as well as long-term use of immunosuppressants (IS). This could influence the risk of COVID-19 and its outcome. Methods We conducted a longitudinal prospective study across 15 rheumatology centres during the first wave of the pandemic to understand the risk factors contributing to COVID-19 in SLE patients. During the 6 months follow-up, those who tested positive for COVID-19, their clinical course and outcome information were recorded. Results Through the study period (April–December 2020), 36/1379 lupus patients (2.9%) developed COVID-19. On analysing the COVID-19 positive versus negative cohort during the study period, male gender (adjusted RR 3.72, 95% C.I. 1.85,7.51) and diabetes (adjusted RR 2.94, 95% C.I. 1.28, 6.79) emerged as the strongest risk factors for COVID-19, in the adjusted analysis. There was no significant influence of organ involvement, hydroxychloroquine, glucocorticoid dosage (prednisolone< 7.5 mg or ≥ 7.5 mg/day) or IS on the risk of COVID-19. There was only one death (1/36) among the lupus patients due to COVID-19. Conclusion Traditional risk factors rather than lupus disease process or IS influenced the risk of COVID-19 in our cohort.

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Do all patients with rheumatic Diseases have a higher risk of COVID 19? Initial results from the Karnataka Rheumatology Association COVID 19 Cohort Study (KRACC)

Cited by 9 publications

References 0 publications

Comparison of Risk Factors During First and Second Wave of COVID-19 in Patients with Autoimmune Rheumatic Diseases (AIRD): Results from KRACC Subset

Comparison of Risk Factors During First and Second Wave of COVID-19 in Patients with Autoimmune Rheumatic Diseases (AIRD): Results from KRACC Subset

A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases

Risk factors associated with COVID-19 in systemic lupus erythematosus: Results from a longitudinal prospective cohort

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