A Prospective Longitudinal Study Evaluating The Influence of Immunosuppressives and Other Factors On COVID-19 in Autoimmune Rheumatic Diseases
Patil et al.,
A Prospective Longitudinal Study Evaluating The Influence of Immunosuppressives and Other Factors On COVID-19..,
Research Square, doi:10.21203/rs.3.rs-805748/v1 (Preprint)
Prospective study of 9,212 autoimmune rheumatic disease patients showing lower mortality with HCQ, without reaching statistical significance. Authors incorrectly state "HCQ use did not influence occurrence of COVID-19 (RR = 0.909, CI (0.715,1.154),
p = 0.432) or mortality (
p = 0.097)"
[nature.com]. CFR for the autoimmune rheumatic disease patients was 4.6 times higher than in the general population from the same area.
risk of death, 65.9% lower, RR 0.34, p = 0.10, treatment 5,266, control 3,946.
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risk of case, 9.1% lower, RR 0.91, p = 0.43, treatment 167 of 5,266 (3.2%), control 147 of 3,946 (3.7%), NNT 181, adjusted per study.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Patil et al., 24 Aug 2021, prospective, India, preprint, 20 authors.
Abstract: A Prospective Longitudinal Study Evaluating The
Influence of Immunosuppressives and Other
Factors On COVID-19 in Autoimmune Rheumatic
Diseases
Abhishek Patil
Manipal Hospital
Chanakya K
St. John’s Medical College Hospital
Padmanabha Shenoy
CARE Hospitals
Chandrashekara S
ChanRe Rheumatology and Immunology Centre
Vikram Haridas
Arthritis Superspeciality centre
Sharath Kumar
OARC
Manisha Daware
Narayana Health
Ramya Janardana
St. John’s Medical College Hospital
Benzeeta Pinto
St. John’s Medical College Hospital
Ramaswamy Subramaniam
JSS Medical College and Hospital
Nagaraj S
Columbia Asia
Yogesh Preet Singh
Manipal Hospital
Shweta Singhai
Sakra Hospital
Ramesh Jois
Vikram Hospital
Vikramraj Jain
Bhagwan Mahaveer Jain Hospital
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Srinivasa C
Fortis Hospital
BG Dharmanand
Vikram Hospital
Chethana Dharmapalaiah
Aster CMI
Sangeetha KN
Anagha Hospital
Vijay K Rao
Manipal Hospital
Vineeta Shobha ( vineeta.s@stjohns.in )
St. John’s Medical College Hospital
Research Article
Keywords: Autoimmune rheumatic diseases, SARS-CoV-2 infection, risk factors, outcome,
hydroxychloroquine, glucocorticoid, immunosuppressants.
DOI: https://doi.org/10.21203/rs.3.rs-805748/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.
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Abstract
Background
We conducted this study to identify the influence of prolonged use of hydroxychloroquine(HCQ),
glucocorticoids (GC) and other immunosuppressants (IS) on occurrence and outcome of COVID-19 in
patients with autoimmune rheumatic diseases (AIRDs).
Methods
This was a prospective, multicenter, non-interventional longitudinal study across 15 specialist
rheumatology centers. Consecutive AIRD patients on treatment with immunosuppressants were recruited
and followed up longitudinally to assess parameters contributing to development of COVID-19 and its
outcome.
Results
COVID-19 occurred in 314(3.45%) of 9212 AIRD patients during a median follow up of 177 (IQR 129,219)
days. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19.
Glucocorticoids in moderate dose (7.5-20mg/day) conferred higher risk (RR = 1.72) of infection. Among
the IS, Mycophenolate mofetil (MMF), Cyclophosphamide (CYC) and Rituximab (RTX) use was higher in
patients with COVID 19. However, the conventional risk factors such as male sex (RR = 1.51), coexistent
diabetes mellitus (RR = 1.64), pre-existing lung disease (RR = 2.01) and smoking (RR = 3.32) were the
major contributing risk factors for COVID-19. Thirteen patients (4.14%) died, the strongest risk factor
being pre-existing lung disease (RR = 6.36, p = 0.01). Incidence ((17.5 vs 5.3 per 1 lakh (Karnataka) and
25.3 vs 7.9 per 1 lakh(Kerala) ) and case fatality (4.1% vs 1.3 % (Karnataka) and 4.3% vs 0.4% (Kerala))
rate of COVID-19 was significantly higher (p < 0.001) compared to the general population of the
corresponding geographic region.
Conclusions
Immunosuppressants have a differential impact on the risk of COVID-19 occurrence in AIRD patients.
Older age, males, smokers, hypertensive, diabetic and underlying lung disease contributed to higher risk.
The incidence rate and the case fatality rate in AIRD patients is much higher than that in the general
population.
Key Message
1. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19 in AIRD.
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2. Glucocorticoids in moderate doses increased the risk of COVID-19 in AIRD patients.
3. The incidence rate of..
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