Incidence and severeness of COVID-19 hospitalisation in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark
Cordtz et al.
, Incidence and severeness of COVID-19 hospitalisation in patients with inflammatory rheumatic disease: a..
, Rheumatology, doi:10.1093/rheumatology/keaa897
Retrospective 58,052 rheumatic disease patients in Denmark showing that RA patients have a higher risk of COVID-19 hospitalization in general. HCQ treated patients show lower risk, although this is not statistically significant with only 3 hospitalizations for HCQ treated patients.
HR 0.76 [0.23-2.52] time-dependent exposure model
HR 0.45 [0.11-1.92] time-fixed exposure model
Although the 24% lower hospitalization is not statistically significant, it is consistent with the significant 16% lower hospitalization [6‑24%]
from meta analysis of the 59 hospitalization results to date
risk of hospitalization, 24.0% lower, HR 0.76, p = 0.67, treatment 3 of 2,722 (0.1%), control 38 of 26,718 (0.1%), NNT 3124, adjusted per study, time-dependent exposure model.
risk of hospitalization, 55.0% lower, HR 0.45, p = 0.28, treatment 3 of 2,722 (0.1%), control 38 of 26,718 (0.1%), adjusted per study, time-fixed exposure model.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Cordtz et al., 28 Dec 2020, retrospective, population-based cohort, Denmark, peer-reviewed, 10 authors.
Advance Access publication 28 December 2020
Incidence and severeness of COVID-19 hospitalization
in patients with inflammatory rheumatic disease:
a nationwide cohort study from Denmark
Objectives. To estimate the incidence of COVID-19 hospitalization in patients with inflammatory rheumatic disease
(IRD); in patients with RA treated with specific DMARDs; and the incidence of severe COVID-19 infection among
hospitalized patients with RA.
Methods. A nationwide cohort study from Denmark between 1 March and 12 August 2020. The adjusted incidence of COVID-19 hospitalization was estimated for patients with RA; spondyloarthritis including psoriatic arthritis;
connective tissue disease; vasculitides; and non-IRD individuals. Further, the incidence of COVID-19 hospitalization
was estimated for patients with RA treated and non-treated with TNF-inhibitors, HCQ or glucocorticoids, respectively. Lastly, the incidence of severe COVID-19 infection (intensive care, acute respiratory distress syndrome or
death) among hospital-admitted patients was estimated for RA and non-IRD sp - individudals.
Results. Patients with IRD (n ¼ 58 052) had an increased partially adjusted incidence of hospitalization with
COVID-19 compared with the 4.5 million people in the general population [hazard ratio (HR) 1.46, 95% CI: 1.15,
1.86] with strongest associations for patients with RA (n ¼ 29 440, HR 1.72, 95% CI: 1.29, 2.30) and vasculitides
(n ¼ 4072, HR 1.82, 95% CI: 0.91, 3.64). There was no increased incidence of COVID-19 hospitalization associated
with TNF-inhibitor, HCQ nor glucocorticoid use. COVID-19 admitted patients with RA had a HR of 1.43 (95% CI:
0.80, 2.53) for a severe outcome.
Conclusion. Patients with IRD were more likely to be admitted with COVID-19 than the general population, and
COVID-19 admitted patients with RA could be at higher risk of a severe outcome. Treatment with specific
DMARDs did not affect the risk of hospitalization.
Key words: rheumatoid arthritis, epidemiology, viruses, DMARDs, biological therapies, immunosupressants
Rheumatology key messages
Patients with IRD had higher incidence of COVID-19 hospitalisation compared with the general population of Denmark.
Among patients with RA, the COVID-19 hospitalisation rates were not higher among those treated with
hydroxychlorquine, TNF-inhibitor or glucocorticoids.
. COVID-19 admitted patients with RA had a tendency towards a higher incidence of severe outcome, but this was
not statistically significant.
Department of Rheumatology, Aalborg University Hospital,
Aalborg, 2Department of Rheumatology, Center for Rheumatology
and Spine Diseases, Gentofte Hospital, Hellerup, 3Lupus and
Vasculitis Clinic, Center for Rheumatology and Spine Diseases,
Rigshospitalet, Copenhagen, 4Department of Clinical Medicine,
Aalborg University, Aalborg, 5Department of Infectious Diseases,
Aalborg University Hospital, Aalborg, 6Department of Cardiology,
Nordsjællands Hospital, Hillerod and 7The DANBIO Register,
Submitted 10 November 2020; accepted 8 December 2020
Correspondence to: René Cordtz, Department of Rheumatology,
Aalborg University Hospital, Reberbansgade 15, DK-9000 Aalborg,
Denmark. E-mail: email@example.comfirstname.lastname@example.org
*René Cordtz and Jesper Lindhardsen contributed equally to this study.
C The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for..
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