Hospital admissions in inflammatory rheumatic diseases during the COVID-19 pandemic: incidence and role of disease modifying agents

Abstract

Background: In this pandemia, it is essential for rheumatologist and patients to know the relationship between COVID-19 and inflammatory rheumatic diseases (IRD). We want to assess the role of targeted synthetic or biologic disease modifying antirheumatic drugs (ts/bDMARDs) and other variables in the development of moderate-severe COVID-19 disease in IRD. Methods: An observational longitudinal study was conducted (1stMar to 15thApr 2020). All patients from the rheumatology outpatient clinic from a hospital in Madrid with a medical diagnosis of IRD were included. Main outcome: hospital admission related to COVID-19. Independent variable: ts/bDMARDs. Covariates: sociodemographic, comorbidities, type of IRD diagnosis, glucocorticoids, NSAIDs and conventional synthetic DMARDs (csDMARDs). Incidence rate (IR) of hospital admission related to COVID-19, was expressed per 1,000 patients-month. Cox multivariate regression analysis was run to examine the influence of ts/bDMARDs and other covariates on IR. Results: 3,591 IRD patients were included (5,896 patients-month). Concerning csDMARDs, methotrexate was the most used followed by antimalarials. 802 patients were on ts/bDMARDs, mainly anti-TNF agents, and rituximab. Hospital admissions related to COVID-19 occurred in 54 patients (1.36%) with an IR of 9.15 [95%CI: 7-11.9]. In the multivariate analysis, older, male gender, presence of comorbidities and specific systemic autoimmune conditions (Sjoegren, polychondritis, Raynaud and mixed connective tissue disease) had more risk of hospital admissions regardless other factors. Exposition to ts/bDMARDs did not achieve statistical signification. Use of glucocorticoids, NSAIDs, and csDMARDs dropped from the final model. Conclusion: This study provides additional evidence in IRD patients regarding susceptibility to moderate-severe infection related to COVID-19.

Potential of regulatory T-cell-based therapies in the management of severe COVID-19

“…An epidemiological survey performed in the large tertiary hospital in Barcelona (Spain) indicated that abatacept-treated patients (42 patients from a cohort of 959 patients treated with biological and synthetic disease-modifying anti-rheumatic drugs (DMARD)) exhibited the lowest frequency of COVID-19-compatible symptoms [25]. Similar data were also obtained from a hospital in Madrid (Spain), where it was noted that none of the 27 abatacept-treated patients (among 802 DMARD-treated patients) were admitted to hospital with COVID-19 symptoms [26]. Furthermore, among 779 biological DMARD-treated patients from Siena (Italy), only two tested positive for COVID-19 and notably none of the 55 abatacept-treated patients in this cohort experienced COVID-19 [27].…”

The impact of the COVID-19 Pandemic on Patients with Chronic Rheumatic Diseases: A Study in 15 Arab Countries

“…The young age of participants (40 years) re ected the pro le of social media users, rather than the usual older age reported in studies on patients with CRD (10,25). In fact, according to the Arab Social Media Report (26), 64.3% of social media users were aged less than 30 years.…”

“…In fact, according to the Arab Social Media Report (26), 64.3% of social media users were aged less than 30 years. On the other hand, the gender of participants (72% females) rather re ected the pro le of patients with CRD (10,25). The same report indicated that 32% of social media users were females, whereas the published cohorts of patients with CRD reported a female prevalence of 72% (10,27).…”

“…Although there was most probably a selection bias towards less severe cases, this low prevalence is in line with previous publications. In a cohort of 3591 of CRD patients from Madrid, a city that was severely affected by the pandemic, 123 COVID-19 cases were reported (3.4%) (27), and hospital admissions related to COVID-19 occurred in 54 patients (1.36%) (25).…”

Impact of the COVID‐19 pandemic on patients with chronic rheumatic diseases: A study in 15 Arab countries

“…The young age of participants (40 years) reflected the profile of social media users, rather than the usual older age reported in studies on patients with CRD. 10,28 In fact, according to the Arab Social Media Report, 29 64.3% of social media users were aged less than 30 years. On the other hand, the gender of participants (72% females) rather reflected the profile of patients with CRD.…”