COVID-19 prognosis in systemic lupus erythematosus compared with rheumatoid arthritis and spondyloarthritis: results from the CONTROL-19 Study by the Italian Society for Rheumatology
Chiara Scirocco, Sara Ferrigno, Laura Andreoli, Micaela Fredi, Claudia Lomater, Luca Moroni, Marta Mosca, Bernd Raffeiner, Greta Carrara, Gianpiero Landolfi, Davide Rozza, Anna Zanetti, Carlo Alberto Scirè, Gian Domenico Sebastiani
Lupus Science & Medicine, doi:10.1136/lupus-2023-000945
Introduction Data concerning SARS-CoV-2 in patients affected by SLE are contradicting. The aim of this study was to investigate disease-related differences in COVID-19 prognosis of patients affected by rheumatic diseases before vaccination; we tested the hypothesis that patients with SLE may have a different outcome compared with those with rheumatoid arthritis (RA) or spondyloarthritis (SPA). Methods We analysed data from the national CONTROL-19 Database with a retrospective, observational design, including rheumatic patients affected by COVID-19. The principal outcome measure was hospitalisation with death or mechanical ventilation. Differences between SLE, RA and SPA were analysed by univariable and multivariable logistic regression models. Results We included 103 patients with SLE (88.2% female, mean age 48.9 years, 50.4% active disease), 524 patients with RA (74.4% female, mean age 60.6 years, 59.7% active disease) and 486 patients with SPA (58.1% female, mean age 53.2 years, 58% active disease). Outcome prevalence was not different between patients with SLE and those with RA (SLE 24.5%, RA 25.6%), while patients with SPA showed a more favourable outcome compared with those with SLE (SPA 15.9%); data from the multivariable analysis confirmed this result. In SLE, age >65 years (OR 17.3, CI 5.51 to 63.16, p<0.001), hypertension (OR 6.2, CI 2.37 to 17.04, p<0.001) and prednisone (PDN) use (OR 3.8, CI 1.43 to 11.39, p=0.01) were associated with severe outcomes, whereas hydroxychloroquine use was found to be protective (OR 0.3, CI 0.14 to 0.91, p=0.03). Conclusion Our data suggest that patients with SLE and RA do not show a different COVID-19 outcome, while patients with SPA have a more favourable disease course compared with those with SLE. Risk of hospitalisation with ventilation or death was associated with age >65 years, hypertension and PDN use in patients with SLE. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ COVID-19 expression in rheumatic diseases has been largely studied in the last 3 years. Some studies reported an increased risk of severe COVID-19 in these patients, while others did not confirm these data. Concerning patients with SLE, data on COVID-19 incidence and prognosis come mainly from case series, reports, observational and retrospective studies, and evidence is controversial. Moreover, little has been investigated about the comparison between SLE and other rheumatic diseases concerning COVID-19 outcome. WHAT THIS STUDY ADDS ⇒ We analysed the national surveillance study's data promoted by the Italian Society for Rheumatology (CONTROL-19 Database) including patients with rheumatic diseases and COVID-19. The principal outcome measure was hospitalisation with death or mechanical ventilation. We included 103 patients with SLE, 524 patients with rheumatoid arthritis (RA) and 486 patients with spondyloarthritis (SPA). According to our results, outcome prevalence was not different between patients with SLE and those with RA,..
Contributors CS, SF, DR, GL, AZ, MM, CAS and GDS were responsible for data analysis and interpretation and gave substantial contribution to the conception of the work. CS, SF, LA, MF, CL, LM, MM, BR, GC, GL, DR, AZ, CAS and GDS wrote the original draft and revised it. CS, SF, MM, CAS and GDS realised and validated the final revision and agreed about all the aspects of the work ensuring that questions related to the accuracy or integrity of it were appropriately investigated. GDS is responsible for the overall content as the guarantor. All authors reviewed and approved the manuscript's content before submission. Competing interests None declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Patient consent for publication Not required. Ethics approval This study involves human participants and was approved by the Ethics Committee of Area Vasta Emilia Centrale on 24 March 2020 (288/2020/Oss/ AOUFe). Encrypted retrospective information was used. Provenance and peer review Not commissioned; externally peer reviewed.
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