Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry
Strangfeld et al.
, Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19..
, Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-219498
Retrospective 3,729 rheumatic disease patients showing lower risk of mortality with HCQ/CQ use (HCQ/CQ vs. no DMARD therapy).
risk of death, 48.0% lower, RR 0.52, p < 0.001, treatment 27 of 426 (6.3%), control 124 of 739 (16.8%), NNT 9.6, adjusted per study, inverted to make RR<1 favor treatment, odds ratio converted to relative risk, HCQ/CQ vs. no DMARD therapy, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Strangfeld et al., 27 Jan 2021, retrospective, multiple countries, peer-reviewed, 37 authors, study period 24 March, 2020 - 1 July, 2020.
Abstract: EPIDEMIOLOGICAL SCIENCE
Factors associated with COVID-19-related death in people
with rheumatic diseases: results from the COVID-19
Global Rheumatology Alliance physician-reported registry
Handling editor Josef S
Anja Strangfeld ,1 Martin Schäfer,1 Milena A Gianfrancesco,2
Saskia Lawson-Tovey,3,4 Jean W Liew,5 Lotta Ljung ,6,7 Elsa F Mateus,8,9
Christophe Richez ,10 Maria J Santos ,11,12,13 Gabriela Schmajuk,2
Carlo A Scirè ,14 Emily Sirotich,15,16 Jeffrey A Sparks,17 Paul Sufka,18
Thierry Thomas,19,20,21 Laura Trupin,2 Zachary S Wallace,22 Sarah Al-Adely,4,23
Javier Bachiller-Corral ,24,25 Suleman Bhana,26 Patrice Cacoub,27,28,29
Loreto Carmona ,30 Ruth Costello ,23 Wendy Costello,31 Laure Gossec ,32,33
Rebecca Grainger,34 Eric Hachulla ,35 Rebecca Hasseli ,36
Jonathan S Hausmann ,37,38 Kimme L Hyrich ,4,23 Zara Izadi,2
Lindsay Jacobsohn,2 Patricia Katz,2 Lianne Kearsley-Fleet ,23
Philip C Robinson ,39,40 Jinoos Yazdany,2 Pedro M Machado ,41,42,43 COVID-19
Global Rheumatology Alliance
Objectives To determine factors associated with
COVID-19-related death in people with rheumatic
Methods Physician-reported registry of adults with
rheumatic disease and confirmed or presumptive
For numbered affiliations see
end of article.
COVID-19 (from 24 March to 1 July 2020). The primary
outcome was COVID-19-related death. Age, sex, smoking
status, comorbidities, rheumatic disease diagnosis,
Dr Pedro M Machado, Centre for
disease activity and medications were included as
Rheumatology, UCL Division of
covariates in multivariable logistic regression models.
Medicine, University College
Analyses were further stratified according to rheumatic
London, London WC1E 6JF, UK;
Results Of 3729 patients (mean age 57 years, 68%
AS and MS contributed equally.
female), 390 (10.5%) died. Independent factors
PCR, JY and PMM contributed
associated with COVID-19-related death were age
(66–75 years: OR 3.00, 95% CI 2.13 to 4.22; >75
Received 11 November 2020
years: 6.18, 4.47 to 8.53; both vs ≤65 years), male
Revised 17 December 2020
sex (1.46, 1.11 to 1.91), hypertension combined with
Accepted 2 January 2021
cardiovascular disease (1.89, 1.31 to 2.73), chronic
Published Online First
27 January 2021
lung disease (1.68, 1.26 to 2.25) and prednisolone-
equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs
no glucocorticoid intake). Moderate/high disease activity
(vs remission/low disease activity) was associated with
higher odds of death (1.87, 1.27 to 2.77). Rituximab
(4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78),
immunosuppressants (azathioprine, cyclophosphamide,
ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to
3.46) and not receiving any disease-modifying anti-
© Author(s) (or their
rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were
employer(s)) 2021. Re-use
associated with higher odds of death, compared with
permitted under CC BY.
Published by BMJ.
methotrexate monotherapy. Other synthetic/biological
DMARDs were not associated with COVID-19-related
To cite: Strangfeld A,
Conclusion Among people with rheumatic disease,
et al. Ann Rheum Dis
COVID-19-related death was associated with known
general factors (older age, male sex and specific
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