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CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory rheumatism or autoimmune diseases

Chevalier et al., Frontiers in Medicine, doi:10.3389/fmed.2023.1152587

Mar 2023

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HCQ for COVID-19

1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 419 studies, recognized in 46 countries.

Lower risk for mortality, hospitalization, progression, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine treatments.

5,100+ studies for 109 treatments. c19hcq.org

Retrospective 1,213 rheumatic disease patients in France, showing lower risk of mortality and severe cases with HCQ use in univariate analysis, without statistical significance.

Although the 35% lower mortality is not statistically significant, it is consistent with the significant 26% lower mortality [22‑30%] from meta analysis of the 253 mortality results to date.

Important missing comments or errors? Let us know.

Study covers colchicine and HCQ.

risk of death, 34.7% lower, RR 0.65, p = 0.19, treatment 7 of 55 (12.7%), control 109 of 535 (20.4%), NNT 13, odds ratio converted to relative risk.

risk of hospitalization, 19.1% lower, RR 0.81, p = 0.36, treatment 15 of 116 (12.9%), control 180 of 1,097 (16.4%), NNT 29, odds ratio converted to relative risk.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Chevalier et al., 22 Mar 2023, retrospective, France, peer-reviewed, mean age 70.3, 24 authors. Contact: raphaele.seror@aphp.fr.

This Paper HCQ All

CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory rheumatism or autoimmune diseases

Kevin Chevalier, Michaël Genin, Thomas Petit Jean, Jerôme Avouac, Rene-Marc Flipo, Sophie Georgin-Lavialle, Soumaya El Mahou, Edouard Pertuiset, Thao Pham, Amelie Servettaz, Hubert Marotte, Fanny Domont, Pascal Chazerain, Mathilde Devaux, Arsene Mekinian, Jérémie Sellam, Bruno Fautrel, Diane Rouzaud, Esther Ebstein, Nathalie Costedoat-Chalumeau, Christophe Richez, Eric Hachulla, Xavier Mariette, Raphaèle Seror

Frontiers in Medicine, doi:10.3389/fmed.2023.1152587

Results: Among 1,213 patients, 195 (16.1%) experienced severe COVID-19. In multivariate analysis, older age, interstitial lung disease (ILD), arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory diseases, and treatment with corticosteroids or rituximab were associated with increased risk of severe COVID-19. Among 35,741 COVID-19 patients in EDS, 316 having AIRDs were compared to 1,264 Propensity score-matched controls. AIRD patients had a higher risk of severe ), p = 0.01] but analysis restricted to rheumatoid arthritis and spondyloarthritis found no increased risk of severe ]. Conclusion: In this multicenter study, we confirmed that AIRD patients treated with rituximab or corticosteroids and/or having vasculitis, autoinflammatory disease, and sarcoidosis had increased risk of severe COVID-19. Also, AIRD patients had, overall, an increased risk of severe COVID-19 compares general population.

Ethics statement This present study was approved by the institutional review board (APHP Scientific and Ethical Committee, authorization no. CSE 20-60_CovAID) from the Scientific and Ethical Committee of the AP-HP and by the CNIL. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Author contributions KC collected the data, analyzed them, and wrote the manuscript. RS, XM, and EH designed the study. MG and TJ performed the statistics and help for the data collection. JA, R-MF, SG-L, SE, EP, TP, AS, HM, FD, PC, MD, AM, JS, BF, DR, EE, NC-C, and CR collected data from the patients. All authors reviewed and corrected the manuscript. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Supplementary material The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2023. 1152587/full#supplementary-material

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{ 'indexed': {'date-parts': [[2023, 3, 23]], 'date-time': '2023-03-23T04:55:26Z', 'timestamp': 1679547326879}, 'reference-count': 68, 'publisher': 'Frontiers Media SA', 'license': [ { 'start': { 'date-parts': [[2023, 3, 22]], 'date-time': '2023-03-22T00:00:00Z', 'timestamp': 1679443200000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': ['frontiersin.org'], 'crossmark-restriction': True}, 'abstract': 'IntroductionAutoimmune/inflammatory rheumatic ' 'diseases (AIRDs) patients might be at-risk of severe COVID-19. However, whether this is ' 'linked to the disease or to its treatment is difficult to determine. This study aimed to ' 'identify factors associated with occurrence of severe COVID-19 in AIRD patients and to ' 'evaluate whether having an AIRD was associated with increased risk of severe COVID-19 or ' 'death.Materials and methodsTwo ' 'databases were analyzed: the EDS (Entrepôt des Données de Santé, Clinical Data Warehouse), ' 'including all patients followed in Paris university hospitals and the French multi-center ' 'COVID-19 cohort [French rheumatic and musculoskeletal diseases (RMD)]. First, in a combined ' 'analysis we compared patients with severe and non-severe COVID-19 to identify factors ' 'associated with severity. Then, we performed a propensity matched score case–control study ' 'within the EDS database to compare AIRD cases and non-AIRD ' 'controls.ResultsAmong 1,213 ' 'patients, 195 (16.1%) experienced severe COVID-19. In multivariate analysis, older age, ' 'interstitial lung disease (ILD), arterial hypertension, obesity, sarcoidosis, vasculitis, ' 'auto-inflammatory diseases, and treatment with corticosteroids or rituximab were associated ' 'with increased risk of severe COVID-19. Among 35,741 COVID-19 patients in EDS, 316 having ' 'AIRDs were compared to 1,264 Propensity score-matched controls. AIRD patients had a higher ' 'risk of severe COVID-19 [aOR = 1.43 (1.08–1.87), p = 0.01] but analysis restricted to ' 'rheumatoid arthritis and spondyloarthritis found no increased risk of severe COVID-19 [aOR = ' '1.11 (0.68–1.81)].ConclusionIn ' 'this multicenter study, we confirmed that AIRD patients treated with rituximab or ' 'corticosteroids and/or having vasculitis, auto-inflammatory disease, and sarcoidosis had ' 'increased risk of severe COVID-19. Also, AIRD patients had, overall, an increased risk of ' 'severe COVID-19 compares general population.', 'DOI': '10.3389/fmed.2023.1152587', 'type': 'journal-article', 'created': {'date-parts': [[2023, 3, 22]], 'date-time': '2023-03-22T04:40:48Z', 'timestamp': 1679460048000}, 'update-policy': 'http://dx.doi.org/10.3389/crossmark-policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory ' 'rheumatism or autoimmune diseases', 'prefix': '10.3389', 'volume': '10', 'author': [ {'given': 'Kevin', 'family': 'Chevalier', 'sequence': 'first', 'affiliation': []}, {'given': 'Michaël', 'family': 'Genin', 'sequence': 'additional', 'affiliation': []}, {'given': 'Thomas Petit', 'family': 'Jean', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jerôme', 'family': 'Avouac', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rene-Marc', 'family': 'Flipo', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sophie', 'family': 'Georgin-Lavialle', 'sequence': 'additional', 'affiliation': []}, {'given': 'Soumaya', 'family': 'El Mahou', 'sequence': 'additional', 'affiliation': []}, {'given': 'Edouard', 'family': 'Pertuiset', 'sequence': 'additional', 'affiliation': []}, {'given': 'Thao', 'family': 'Pham', 'sequence': 'additional', 'affiliation': []}, {'given': 'Amelie', 'family': 'Servettaz', 'sequence': 'additional', 'affiliation': []}, {'given': 'Hubert', 'family': 'Marotte', 'sequence': 'additional', 'affiliation': []}, {'given': 'Fanny', 'family': 'Domont', 'sequence': 'additional', 'affiliation': []}, {'given': 'Pascal', 'family': 'Chazerain', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mathilde', 'family': 'Devaux', 'sequence': 'additional', 'affiliation': []}, {'given': 'Arsene', 'family': 'Mekinian', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jérémie', 'family': 'Sellam', 'sequence': 'additional', 'affiliation': []}, {'given': 'Bruno', 'family': 'Fautrel', 'sequence': 'additional', 'affiliation': []}, {'given': 'Diane', 'family': 'Rouzaud', 'sequence': 'additional', 'affiliation': []}, {'given': 'Esther', 'family': 'Ebstein', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Nathalie', 'family': 'Costedoat-Chalumeau', 'sequence': 'additional', 'affiliation': []}, {'given': 'Christophe', 'family': 'Richez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Eric', 'family': 'Hachulla', 'sequence': 'additional', 'affiliation': []}, {'given': 'Xavier', 'family': 'Mariette', 'sequence': 'additional', 'affiliation': []}, {'given': 'Raphaèle', 'family': 'Seror', 'sequence': 'additional', 'affiliation': []}], 'member': '1965', 'published-online': {'date-parts': [[2023, 3, 22]]}, 'reference': [ { 'key': 'B1', 'doi-asserted-by': 'crossref', 'first-page': 'e419', 'DOI': '10.1016/S2665-9913(21)00059-X', 'article-title': 'COVID-19 outcomes in patients with inflammatory rheumatic and ' 'musculoskeletal diseases treated with rituximab: a cohort study.', 'volume': '3', 'author': 'Avouac', 'year': '2021', 'journal-title': 'Lancet Rheumatol.'}, { 'key': 'B2', 'author': 'Cascella', 'year': '2022', 'journal-title': 'Features, Evaluation, and Treatment of Coronavirus (COVID-19). 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'10.1016/j.clml.2020.08.017', 'article-title': 'Persistent COVID-19 pneumonia and failure to develop Anti-SARS-CoV-2 ' 'antibodies during rituximab maintenance therapy for follicular ' 'lymphoma.', 'volume': '20', 'author': 'Yasuda', 'year': '2020', 'journal-title': 'Clin Lymph Myeloma Leukem.'}, { 'key': 'B62', 'doi-asserted-by': 'publisher', 'first-page': '1087', 'DOI': '10.1016/j.semarthrit.2020.06.013', 'article-title': 'Long, relapsing, and atypical symptomatic course of COVID-19 in a ' 'B-cell-depleted patient after rituximab.', 'volume': '50', 'author': 'Leipe', 'year': '2020', 'journal-title': 'Semin Arthr Rheum.'}, { 'key': 'B63', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fonc.2020.01578', 'article-title': 'Prolonged course of COVID-19-Associated pneumonia in a B-Cell depleted ' 'patient after rituximab.', 'volume': '10', 'author': 'Kos', 'year': '2020', 'journal-title': 'Front Oncol.'}, { 'key': 'B64', 'doi-asserted-by': 'publisher', 'first-page': '1100', 'DOI': '10.1111/bjh.17266', 'article-title': 'Convalescent plasma treatment of persistent severe acute respiratory ' 'syndrome coronavirus-2 (SARS-CoV-2) infection in patients with lymphoma ' 'with impaired humoral immunity and lack of neutralising antibodies.', 'volume': '192', 'author': 'Betrains', 'year': '2021', 'journal-title': 'Br J Haematol.'}, { 'key': 'B65', 'doi-asserted-by': 'publisher', 'first-page': '2624', 'DOI': '10.1182/bloodadvances.2021004629', 'article-title': 'Vaccine response following anti-CD20 therapy: a systematic review and ' 'meta-analysis of 905 patients.', 'volume': '5', 'author': 'Vijenthira', 'year': '2021', 'journal-title': 'Blood Adv.'}, { 'key': 'B66', 'doi-asserted-by': 'crossref', 'first-page': '1357', 'DOI': '10.1136/annrheumdis-2021-220604', 'article-title': 'Rituximab, but not other antirheumatic therapies, is associated with ' 'impaired serological response to SARS-CoV-2 vaccination in patients ' 'with rheumatic diseases.', 'volume': '80', 'author': 'Spiera', 'year': '2021', 'journal-title': 'Ann Rheum Dis.'}, { 'key': 'B67', 'doi-asserted-by': 'publisher', 'first-page': '927', 'DOI': '10.1002/art.42058', 'article-title': 'Rituximab impairs B cell response but not T Cell response to COVID-19 ' 'vaccine in autoimmune diseases.', 'volume': '74', 'author': 'Bitoun', 'year': '2022', 'journal-title': 'Arthr Rheumatol.'}, { 'key': 'B68', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fmed.2022.997876', 'article-title': 'COVID-19 and rheumatic diseases: a mini-review.', 'volume': '9', 'author': 'Roseti', 'year': '2022', 'journal-title': 'Front Med.'}], 'container-title': 'Frontiers in Medicine', 'original-title': [], 'link': [ { 'URL': 'https://www.frontiersin.org/articles/10.3389/fmed.2023.1152587/full', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 3, 22]], 'date-time': '2023-03-22T04:41:00Z', 'timestamp': 1679460060000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.frontiersin.org/articles/10.3389/fmed.2023.1152587/full'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 3, 22]]}, 'references-count': 68, 'alternative-id': ['10.3389/fmed.2023.1152587'], 'URL': 'http://dx.doi.org/10.3389/fmed.2023.1152587', 'relation': {}, 'ISSN': ['2296-858X'], 'subject': ['General Medicine'], 'container-title-short': 'Front. Med.', 'published': {'date-parts': [[2023, 3, 22]]}}

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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.

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