Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance
Manuel Francisco Ugarte-Gil, Graciela S Alarcón, Zara Izadi, Ali Duarte-García, Cristina Reátegui-Sokolova, Ann Elaine Clarke, Leanna Wise, Guillermo J Pons-Estel, Maria Jose Santos, Sasha Bernatsky, Sandra Lúcia Euzébio Ribeiro, Samar Al Emadi, Jeffrey A Sparks, Null- T Hsu, Naomi J Patel, Emily L Gilbert, Maria O Valenzuela-Almada, Andreas Jönsen, Gianpiero Landolfi, Micaela Fredi, Tiphaine Goulenok, Mathilde Devaux, Xavier Mariette, Viviane Queyrel, Vasco C Romão, Graca Sequeira, Rebecca Hasseli, Bimba Hoyer, Reinhard E Voll, Christof Specker, Roberto Baez, Vanessa Castro-Coello, Hernan Maldonado Ficco, Edgard Torres Reis Neto, Gilda Aparecida Aparecida Ferreira, Odirlei Andre André Monticielo, Emily Sirotich, Jean Liew, Jonathan Hausmann, Paul Sufka, Rebecca Grainger, Suleman Bhana, Wendy Costello, Zachary S Wallace, Lindsay Jacobsohn, Tiffany Taylor, Clairissa Ja, Anja Strangfeld, Elsa F Mateus, Kimme L Hyrich, Loreto Carmona, Saskia Lawson-Tovey, Lianne Kearsley-Fleet, Martin Schäfer, Pedro M Machado, Philip C Robinson, Milena Gianfrancesco, Jinoos Yazdany
Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2021-221636
Aim To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19. Methods People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity. Results A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1-5 mg/day 1.86, 1.20 to 2.66, 6-9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab. Conclusions More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.
Contributors MFU-G, GSA, MG and JY had access to the study data, developed the figures and tables and vouch for the data and analyses. AMG performed the statistical analyses and contributed to data quality control, data analysis and interpretation of data. All authors contributed to data collection, data analysis and interpretation of data. MFU-G, GSA, MG and JY directed the work, designed the data collection methods, contributed to data collection, data analysis and interpretation of data and had final responsibility for the decision to submit for publication. All authors contributed intellectual content during the drafting and revision of the work and approved the final version to be published. JY is the guarantor. Competing interests MFU-G has received research grants from Pfizer and Janssen, not related to this manuscript. AD-G is supported by the Rheumatology Research Foundation (Scientist Development Award) and the Centers for Disease Control and Prevention. CR-S has received research grants from Janssen, not related to this manuscript. AEC has received consulting fees from AstraZeneca, BMS and GSK, all unrelated to this manuscript. LW has received consulting fees and speaker's honoraria from Aurinia Pharma unrelated to this manuscript. GJP-E reports no competing interests related to this work. Outside of this work, he reports personal consulting and/or speaking fees from Pfizer, GSK, Janssen and Sanofi (all <US$10 000). MJS has received speaker's fees from AbbVie,..
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DOI record:
{
"DOI": "10.1136/annrheumdis-2021-221636",
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"abstract": "<jats:sec><jats:title>Aim</jats:title><jats:p>To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1–5 mg/day 1.86, 1.20 to 2.66, 6–9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.</jats:p></jats:sec>",
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