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All Studies   Meta Analysis    Recent:   

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., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-219498
Jan 2021  
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Mortality 48% Improvement Relative Risk HCQ for COVID-19  Strangfeld et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 1,165 patients in multiple countries (Mar - Jul 2020) Lower mortality with HCQ (p=0.000084) c19hcq.org Strangfeld et al., Annals of the Rheum.., Jan 2021 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19hcq.org
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.
This PaperHCQAll
Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry
Anja Strangfeld, Martin Schäfer, Milena A Gianfrancesco, Saskia Lawson-Tovey, Jean W Liew, Lotta Ljung, Elsa F Mateus, Christophe Richez, Maria J Santos, Gabriela Schmajuk, Carlo A Scirè, Emily Sirotich, Jeffrey A Sparks, Paul Sufka, Thierry Thomas, Laura Trupin, Zachary S Wallace, Sarah Al-Adely, Javier Bachiller-Corral, Suleman Bhana, Patrice Cacoub, Loreto Carmona, Ruth Costello, Wendy Costello, Laure Gossec, Rebecca Grainger, Eric Hachulla, Rebecca Hasseli, Jonathan S Hausmann, Kimme L Hyrich, Zara Izadi, Lindsay Jacobsohn, Patricia Katz, Lianne Kearsley-Fleet, Philip C Robinson, Jinoos Yazdany, Dr Pedro M Machado
Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-219498
Objectives To determine factors associated with COVID-19-related death in people with rheumatic diseases. Methods Physician-reported registry of adults with rheumatic disease and confirmed or presumptive March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Results Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisoloneequivalent 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 antirheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Conclusion Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance Key messages What is already known about this subject? ⇒ To date, most available data on outcomes for people with rheumatic diseases infected with SARS-CoV-2 come from single centre or single country case series or from one large international registry; the COVID-19 Global Rheumatology Alliance (GRA) physician registry. ⇒ The first GRA publication identified factors associated with higher odds of COVID-19 hospitalisation, including older age, presence of comorbidities and higher dosages of glucocorticoids (≥10 mg/day of prednisolone equivalent). ⇒ Clinical outcome information on patients with COVID-19 who have rheumatic disease therefore remains limited, particularly with regard to factors associated with COVID-19related death. What does this study add? ⇒ In this analysis of 3729 patients with rheumatic diseases, older age, male sex, and cardiovascular and chronic lung disease were associated with COVID-19-related death. ⇒ Disease-specific factors, namely, moderate/ high disease activity and certain medications (rituximab, sulfasalazine and immunosuppressants (as opposed to immunomodulators..
SUPPLEMENTARY TABLES Missing values imputed via multiple imputation, patient numbers may thus be rounded. Effects significant at level α=0.05 are marked in bold. Patients were excluded from a particular analysis if the medication they received provided ≤ 20 patients for that analysis or if there were no deaths reported for that specific medication. CI, confidence interval; CTD, connective tissue diseases; CVD, cardiovascular disease; DA, disease activity; DMARD, disease modifying antirheumatic drugs; GC, glucocorticoids; IJD, inflammatory joint diseases; IL, interleukin; JIA, juvenile idiopathic arthritis; N, number; OR, odds ratio; SLE, systemic lupus erythematosus; TNF; tumour necrosis factor; tsDMARD, targeted synthetic disease modifying antirheumatic drugs. BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Missing values imputed via multiple imputation, patient numbers may thus be rounded. Effects significant at level α=0.05 are marked in bold. Patients were excluded from a particular analysis if the medication they received provided ≤ 20 patients for that analysis or if there were no deaths reported for that specific medication. CI, confidence interval; CTD, connective tissue diseases; CVD, cardiovascular disease; DA, disease activity; DMARD, disease modifying antirheumatic drugs; GC, glucocorticoids; IJD, inflammatory..
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The primary outcome was COVID-19-related death. Age, sex, smoking ' 'status, comorbidities, rheumatic disease diagnosis, disease activity and medications were ' 'included as covariates in multivariable logistic regression models. Analyses were further ' 'stratified according to rheumatic disease ' 'category.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 3729 ' 'patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated ' 'with COVID-19-related death were age (66–75 years: OR 3.00, 95% CI 2.13 to 4.22; &gt;75 ' 'years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension ' 'combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 ' 'to 2.25) and prednisolone-equivalent dosage &gt;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-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were ' 'associated with higher odds of death, compared with methotrexate monotherapy. Other ' 'synthetic/biological DMARDs were not associated with COVID-19-related ' 'death.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Among people ' 'with rheumatic disease, COVID-19-related death was associated with known general factors ' '(older age, male sex and specific comorbidities) and disease-specific factors (disease ' 'activity and specific medications). The association with moderate/high disease activity ' 'highlights the importance of adequate disease control with DMARDs, preferably without ' 'increasing glucocorticoid dosages. 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'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://syndication.highwire.org/content/doi/10.1136/annrheumdis-2020-219498', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 7, 4]], 'date-time': '2022-07-04T16:20:34Z', 'timestamp': 1656951634000}, 'score': 1, 'resource': {'primary': {'URL': 'https://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2020-219498'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021, 1, 27]]}, 'references-count': 30, 'journal-issue': { 'issue': '7', 'published-online': {'date-parts': [[2021, 6, 17]]}, 'published-print': {'date-parts': [[2021, 7]]}}, 'alternative-id': ['10.1136/annrheumdis-2020-219498'], 'URL': 'http://dx.doi.org/10.1136/annrheumdis-2020-219498', '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': [[2021, 1, 27]]}}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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