Clinical Course and Outcomes of coronavirus disease 2019 (COVID-19) in Rheumatic Disease Patients on Immunosuppression: A case Cohort Study at a Single Center with a Significantly Diverse Population
Timothy Arleo, M.D David Tong, Julie Shabto, Ghazala O’keefe, M.D Arezou Khosroshahi
doi:10.1101/2020.10.26.20219154
Objectives To determine clinical course and outcomes in rheumatic disease patients with coronavirus disease 2019 (COVID-19) and compare results to uninfected patients.
Methods We conducted a case cohort study of autoimmune disease patients with COVID-19 (confirmed by severe acute respiratory syndrome coronavirus 2 PCR) from 02/01/2020 to 07/31/2020 and compared them in a 1:3 ratio with uninfected patients who were matched based on race, age, sex, and comorbidity index. Patient demographics, clinical course, and outcomes were compared among these patient groups.
Results A total of 70 rheumatic disease patients with COVID-19 (mean age, 56.6 years; 64% African American) were identified. The 34 (49%) patients who were hospitalized used oral glucocorticoids more frequently (p<0.01). All 10 patients on anti-TNFα medications were treated as outpatients (p<0.01). Those hospitalized with COVID-19 more often required ICU admission (17 (50%) vs 27 (26%), OR=2.78 (95% CI: 1.24 to 6.20)) and intubation (10 (29%) vs 6 (6%), OR=6.67 (95% CI: 2.20 to 20.16)) than uninfected patients. They also had higher mortality rates (6 (18%) vs 3 (3%), OR=7.21 (95% CI: 1.70 to 30.69)). Of the six COVID-19 patients who died, one was of African ancestry (p=0.03).
Conclusions . Rheumatic disease patients infected with COVID-19 were more likely to require ICU admission, ventilation, and died more frequently versus uninfected patients with autoimmune disease. Patients on anti-TNFα medications were hospitalized less frequently while those on chronic glucocorticoids were hospitalized more frequently. These findings have important implications for medication choice in rheumatic disease patients during the ongoing spread of COVID-19.
Conflicts of Interest: None declared
Admitted, infected patients who died versus patients who survived In total, six of the 70 COVID-19 patients died, resulting in a 9% overall mortality rate (18% mortality rate among those hospitalized). Among admitted patients with COVID-19, the distribution of sex was similar between patients who died and survived, but patients with COVID-19 who died were older with a mean age of 76.5 vs 62.8 for those that survived (p<0.01) (table 5 ). What is already known? • Not much is known about COVID-19 outcomes in patients with underlying rheumatic disease especially compared to rheumatic disease patients hospitalized for other causes. What does this study add? • We found that rheumatic disease patients with COVID-19 had poorer outcomes including ICU admission, ventilation, and death compared to uninfected rheumatic disease patients. • This study adds further support regarding protective effects of anti-TNFα medications in COVID-19 disease course as 0 of 10 of these patients required hospitalization.
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