SARS–CoV‐2 Infection and COVID‐19 Outcomes in Rheumatic Diseases: A Systematic Literature Review and Meta‐Analysis

Abstract

Objective The relative risk of SARS–CoV‐2 infection and COVID‐19 disease severity among people with rheumatic and musculoskeletal diseases (RMDs) compared to those without RMDs is unclear. This study was undertaken to quantify the risk of SARS–CoV‐2 infection in those with RMDs and describe clinical outcomes of COVID‐19 in these patients. Methods We conducted a systematic literature review using 14 databases from January 1, 2019 to February 13, 2021. We included observational studies and experimental trials in RMD patients that described comparative rates of SARS–CoV‐2 infection, hospitalization, oxygen supplementation/intensive care unit (ICU) admission/mechanical ventilation, or death attributed to COVID‐19. Methodologic quality was evaluated using the Joanna Briggs Institute critical appraisal tools or the Newcastle‐Ottawa scale. Risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated, as applicable for each outcome, using the Mantel‐Haenszel formula with random effects models. Results Of the 5,799 abstracts screened, 100 studies met the criteria for inclusion in the systematic review, and 54 of 100 had a low risk of bias. Among the studies included in the meta‐analyses, we identified an increased prevalence of SARS–CoV‐2 infection in patients with an RMD (RR 1.53 [95% CI 1.16–2.01]) compared to the general population. The odds of hospitalization, ICU admission, and mechanical ventilation were similar in patients with and those without an RMD, whereas the mortality rate was increased in patients with RMDs (OR 1.74 [95% CI 1.08–2.80]). In a smaller number of studies, the adjusted risk of outcomes related to COVID‐19 was assessed, and the results varied; some studies demonstrated an increased risk while other studies showed no difference in risk in patients with an RMD compared to those without an RMD. Conclusion Patients with RMDs have higher rates of SARS–CoV‐2 infection and an increased mortality rate.

Different Covid-19 Outcomes Among Systemic Rheumatic Diseases: A Nation-wide Cohort Study

“…Regarding the risk of Covid-19 infection, with the exception of AS patients, all other patient subgroups were at higher risk, in agreement also with a general populationbased cohort study [18]and two recent-metanalyses [4,5]. However, the possibility that these patients were more susceptible to increased rates of testing cannot be excluded.…”

“…Similar results were presented in a recent meta-analysis examining data from 26 observational studies[4]. On the other hand, a large meta-analysis of 71 studies showed that patients with systemic rheumatic disease displayed increased odds for mortality[5]. The same uncertainty also applies to the question whether systemic rheumatic disease patients are more susceptible to contracting Covid-19, with systematic literature reviews and meta-analyses having discordant results[3–5].…”

“…On the other hand, a large meta-analysis of 71 studies showed that patients with systemic rheumatic disease displayed increased odds for mortality [5]. The same uncertainty also applies to the question whether systemic rheumatic disease patients are more susceptible to contracting Covid-19, with systematic literature reviews and metaanalyses having discordant results [3][4][5]. Moreover, the known increased rates of concomitant comorbidities, including arterial hypertension, cardiovascular disease, diabetes, and malignancy [6][7][8][9][10][11][12] may have a major additional impact.…”

Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

“…To date, it is still not clear whether a reduced antibody response is invariably linked to an increased susceptibility to COVID-19. In fact, it has been reported that rates of SARS-CoV-2 infection appear to be similar between general population and patients with rheumatic diseases receiving DMARDs or biologics (29), including psoriasis (22,(30)(31)(32)(33)(34)(35). In addition, those patients do not seem to have an increased risk of hospitalization or death from COVID-19, although generally burdened by higher rates of metabolic and cardiovascular comorbidities (36-40).…”

Breakthrough SARS-CoV-2 infections in immune mediated disease patients undergoing B cell depleting therapy

“…While there is great heterogeneity in the capacity of specific immunosuppressive agents to limit the integrated immune response to both natural infection as well as vaccines, of particular concern is the class of B cell depleting therapies (BCDTs) widely used to treat an array of IMIDs. Before the introduction of vaccines, treatment of both rheumatic and neurologic IMIDs with such BCDTs was associated with more severe COVID-19 [3][4][5][6][7][8][9] . Furthermore, numerous studies have documented the capacity for BCDTs such as rituximab and ocrelizumab to profoundly impair humoral response to numerous vaccines including SARS-CoV-2 [10][11][12][13] .…”