Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry
Milena Gianfrancesco, Kimme L Hyrich, Sarah Al-Adely, Loreto Carmona, Maria I Danila, Laure Gossec, Zara Izadi, Lindsay Jacobsohn, Patricia Katz, Saskia Lawson-Tovey, Elsa F Mateus, Stephanie Rush, Gabriela Schmajuk, Julia Simard, Anja Strangfeld, Laura Trupin, Katherine D Wysham, Suleman Bhana, Wendy Costello, Rebecca Grainger, Jonathan S Hausmann, Jean W Liew, Emily Sirotich, Paul Sufka, Zachary S Wallace, Jinoos Yazdany, Pedro M Machado, Dr Philip C Robinson
Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-217871
Objectives COViD-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COViD-19 hospitalisation status in people with rheumatic disease. Methods Case series of individuals with rheumatic disease and COViD-19 from the COViD-19 Global Rheumatology alliance registry: 24 March 2020 to 20 april 2020. Multivariable logistic regression was used to estimate ORs and 95% Cis of hospitalisation. age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed. results a total of 600 cases from 40 countries were included. nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. in multivariableadjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% Ci 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMaRD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% Ci 0.70 to 2.17 and OR 0.74, 95% Ci 0.37 to 1.46, respectively). non-steroidal antiinflammatory drug (nsaiD) use was not associated with hospitalisation status (OR 0.64, 95% Ci 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TnF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% Ci 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% Ci 0.57 to 1.57) was observed. Conclusions We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TnF with a decreased odds of hospitalisation in patients with rheumatic disease. neither exposure to DMaRDs nor nsaiDs were associated with increased odds of hospitalisation.
InTrOduCTIOn The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is of particular concern for people with rheumatic disease or those who are immunosuppressed. Whether having a rheumatic disease or receiving immunosuppressive treatment is associated with severe infection and subsequent poor outcomes is unknown. In general, immunosuppression and the presence of comorbidities are associated with an increased risk of serious infection in people with
Key messages What is already known about this subject? ► Data regarding outcomes for people with rheumatological disease and COVID-19 remain scarce and limited to small case series. ► Due to underlying immune system dysfunction and the common use of immunosuppressants, there is concern about poorer outcomes in this population and uncertainty about medication management during the pandemic.
What does this study add? ► Moderate to high dose glucocorticoids were associated with a higher risk of hospitalisation for COVID-19. ► Biologic therapies, NSAIDs and antimalarial drugs like hydroxychloroquine were not associated with a higher risk of hospitalisation for COVID-19.
How might..
References
Arentz, Yim E, Klaff L, Characteristics and outcomes of 21 critically ill patients with COViD-19 in Washington state, JAMA,
doi:10.1001/jama.2020.4326Borba, Val, Vs, Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (saRs-CoV-2) infection: preliminary safety results of a randomized, double-blinded, phase iib clinical trial
Chen, Hu, Zhang, efficacy of hydroxychloroquine in patients with COViD-19: results of a randomized clinical trial, MedRxiv
Chen, Liu, a pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COViD-19
Chen, Wu, Chen, Clinical characteristics of 113 deceased patients with coronavirus disease, BMJ,
doi:10.1136/bmj.m1091Favalli, Caporali, incidence and clinical course of COViD-19 in patients with connective tissue diseases: a descriptive observational analysis, J Rheumatol,
doi:10.3899/jrheum.200507Gautret, Lagier, Parola, Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COViD-19 patients with at least a six-day follow up: an observational study, Travel Med Infect Dis
Gautret, Parola, Hydroxychloroquine and azithromycin as a treatment of COViD-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents,
doi:10.1016/j.ijantimicag.2020.105949Gianfrancesco, Kl, Gossec L, Rheumatic disease and COViD-19: initial data from the COViD-19 global rheumatology alliance provider registry, Lancet Rheumatol
Goyal, Choi, Pinheiro, Clinical characteristics of Covid-19 in new York City, N Engl J Med Overseas Ed,
doi:10.1056/NEJMc2010419Grasselli, Zangrillo A, Zanella A, Baseline characteristics and outcomes of 1591 patients infected with saRs-CoV-2 admitted to iCUs of the lombardy region, italy, JAMA,
doi:10.1001/jama.2020.5394Guan, Zy N, Hu, Clinical characteristics of coronavirus disease 2019 in China, N Engl J Med
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Kim Ahj, Sparks, Liew, a rush to judgment? rapid reporting and dissemination of results and its consequences regarding the use of hydroxychloroquine for COViD-19, Ann Intern Med,
doi:10.7326/M20-1223Konig, Scheetz, Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude saRs-CoV-2 infection and severe COViD-19
Listing, Gerhold, Zink, The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment, Rheumatology,
doi:10.1093/rheumatology/kes305Luo, Liu, Qiu L, Tocilizumab treatment in COViD-19: a single center experience, J Med Virol,
doi:10.1002/jmv.25801Magagnoli, Pereira, Outcomes of hydroxychloroquine usage in United states veterans hospitalized with Covid-19, medRxiv
Mahevas, Tran, Roumier, evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COViD-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial, medRxiv
Mathian A, Mahevas, Rohmer, Clinical course of coronavirus disease 2019 (COViD-19) in a series of 17 patients with systemic lupus erythematosus under longterm treatment with hydroxychloroquine, Ann Rheum Dis
Mikuls, Johnson Sr, Fraenkel L, american College of rheumatology guidance for the management of adult patients with rheumatic disease during the COViD-19 pandemic, Arthritis Rheumatol,
doi:10.1002/art.41301Monti S, Balduzzi S, Delvino, Clinical course of COViD-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies, Ann Rheum Dis
Richardson S, Js, Narasimhan, Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COViD-19 in the new York City area, JAMA,
doi:10.1001/jama.2020.6775Rmb, Machado, Kroon, eUlaR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of saRs-CoV-2, Ann Rheum Dis
Ruan, Yang, Wang, Treatment benefit or survival of the fittest: what drives the time-dependent decrease in serious infection rates under TnF inhibition and what does this imply for the individual patient?, Intensive Care Med,
doi:10.1136/ard.2011.151043Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019 (COViD-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention, JAMA
Xu, Han, Li, effective treatment of severe COViD-19 patients with tocilizumab, ChinaXiv
Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COViD-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3Zs, Bhana S, Js, The rheumatology community responds to the COViD-19 pandemic: the establishment of the COViD-19 global rheumatology alliance, Rheumatology,
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'abstract': '<jats:sec><jats:title>Objectives</jats:title><jats:p>COVID-19 outcomes in people with '
'rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical '
'factors associated with COVID-19 hospitalisation status in people with rheumatic '
'disease.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Case series of '
'individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology '
'Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used '
'to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease '
'diagnosis, comorbidities and rheumatic disease medications taken immediately prior to '
'infection were '
'analysed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 600 '
'cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) '
'and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10\u2009mg/day was '
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'association with antimalarial use (OR 0.94, 95%\u2009CI 0.57 to 1.57) was '
'observed.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>We found '
'that glucocorticoid exposure of ≥10\u2009mg/day is associated with a higher odds of '
'hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with '
'rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds '
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'date-time': '2021-05-13T06:16:02Z',
'timestamp': 1620886562000},
'score': 1,
'resource': {'primary': {'URL': 'https://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2020-217871'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2020, 5, 29]]},
'references-count': 37,
'journal-issue': { 'issue': '7',
'published-online': {'date-parts': [[2020, 6, 14]]},
'published-print': {'date-parts': [[2020, 7]]}},
'alternative-id': ['10.1136/annrheumdis-2020-217871'],
'URL': 'http://dx.doi.org/10.1136/annrheumdis-2020-217871',
'relation': {},
'ISSN': ['0003-4967', '1468-2060'],
'subject': [ 'General Biochemistry, Genetics and Molecular Biology', 'Immunology', 'Immunology and Allergy',
'Rheumatology'],
'container-title-short': 'Ann Rheum Dis',
'published': {'date-parts': [[2020, 5, 29]]}}
