COVID-19 in patients with rheumatic disease in Hubei province, China: a multicentre retrospective observational study
Prof Jixin Zhong, MD Guifen Shen, Huiqin Yang, MD Anbin Huang, MD Xiaoqi Chen, Li Dong, MD Bin Wu, MD Anbin Zhang, Linchong Su, Xiaoqiang Hou, Shulin Song, Huiling Li, Wenyu Zhou, MD Tao Zhou, MD Qin Huang, Aichun Chu, Zachary Braunstein, Xiaoquan Rao, MD Cong Ye, Prof Lingli Dong
The Lancet Rheumatology, doi:10.1016/s2665-9913(20)30227-7
Background In the ongoing COVID-19 pandemic, the susceptibility of patients with rheumatic diseases to COVID-19 remains unclear. We aimed to investigate susceptibility to COVID-19 in patients with autoimmune rheumatic diseases during the ongoing COVID-19 pandemic. Methods We did a multicentre retrospective study of patients with autoimmune rheumatic diseases in Hubei province, the epicentre of the COVID-19 outbreak in China. Patients with rheumatic diseases were contacted through an automated telephone-based survey to investigate their susceptibility to COVID-19. Data about COVID-19 exposure or diagnosis were collected. Families with a documented history of COVID-19 exposure, as defined by having at least one family member diagnosed with COVID-19, were followed up by medical professionals to obtain detailed information, including sex, age, smoking history, past medical history, use of medications, and information related to COVID-19. Findings Between March 20 and March 30, 2020, 6228 patients with autoimmune rheumatic diseases were included in the study. The overall rate of COVID-19 in patients with an autoimmune rheumatic disease in our study population was 0•43% (27 of 6228 patients). We identified 42 families in which COVID-19 was diagnosed between Dec 20, 2019, and March 20, 2020, in either patients with a rheumatic disease or in a family member residing at the same physical address during the outbreak. Within these 42 families, COVID-19 was diagnosed in 27 (63%) of 43 patients with a rheumatic disease and in 28 (34%) of 83 of their family members with no rheumatic disease (adjusted odds ratio [OR] 2•68 [95% CI 1•14-6•27]; p=0•023). Patients with rheumatic disease who were taking hydroxychloroquine had a lower risk of COVID-19 infection than patients taking other disease-modifying anti-rheumatic drugs (OR 0•09 [95% CI 0•01-0•94]; p=0•044). Additionally, the risk of COVID-19 was increased with age (adjusted OR 1•04 [95% CI 1•01-1•06]; p=0•0081). Interpretation Patients with autoimmune rheumatic disease might be more susceptible to COVID-19 infection than the general population.
References
Arabi, Mandourah, Al-Hameed, Corticosteroid therapy for critically ill patients with Middle East respiratory syndrome, Am J Respir Crit Care Med
Borba, Val, Sampaio, Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: a randomized clinical trial, JAMA Netw Open
Caporali, Caprioli, Bobbio-Pallavicini, Montecucco, DMARDS and infections in rheumatoid arthritis, Autoimmun Rev
Caporali, Caprioli, Bobbio-Pallavicini, Montecucco, DMARDS and infections in rheumatoid arthritis, Autoimmun Rev
Cavalli, Luca, Campochiaro, Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study, Lancet Rheumatol
Chen, Hu, Zhang, Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial, medRxiv,
doi:10.1101/2020.03.22.20040758Figueroa-Parra, Aguirre-Garcia, Gamboa-Alonso, Camacho-Ortiz, Galarza-Delgado et al., Are my patients with rheumatic diseases at higher risk of COVID-19?, Ann Rheum Dis
Geleris, Sun, Platt, Observational study of hydroxychloroquine in hospitalized patients with Covid-19, N Engl J Med
Gianfrancesco, Hyrich, Al-Adely, Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry, Ann Rheum Dis
Goyal, Bulua, Nikolov, Schwartzberg, Siegel, Rheumatologic and autoimmune manifestations of primary immunodeficiency disorders, Curr Opin Rheumatol
Guan, Liang, Zhao, Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis, Eur Respir J
Hay, Haw, Hanage, Metcalf, Mina, Implications of the age profile of the novel coronavirus
Huang, Li, Xiao, Preliminary evidence from a multicenter prospective observational study of the safety and efficacy of chloroquine for the treatment of COVID-19, Natl Sci Rev,
doi:10.1093/nsr/nwaa113Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Huet, Beaussier, Voisin, Anakinra for severe forms of COVID-19: a cohort study, Lancet Rheumatol
Lauer, Grantz, Bi, The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application, Ann Intern Med
Li, Pei, Chen, Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2), Science
Liu, Cao, Xu, Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discov
Mahévas, Tran, Roumier, Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data, BMJ
Mehta, Mcauley, Brown, Sanchez, Tattersall et al., COVID-19: consider cytokine storm syndromes and immunosuppression, Lancet
Monti, Balduzzi, Delvino, Bellis, Quadrelli et al., Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies, Ann Rheum Dis
Monti, Montecucco, Can hydroxychloroquine protect patients with rheumatic diseases from COVID-19? Response to: 'Does hydroxychloroquine prevent the transmission of COVID-19?' by Heldwein and Calado and 'SLE, hydroxychloroquine and no SLE patients with COVID-19: a comment' by Joob and Wiwanitkit, Ann Rheum Dis
Shen, Wang, Zhao, Treatment of 5 critically ill patients with COVID-19 with convalescent plasma, JAMA
Tang, Cao, Han, Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial, BMJ
Thevarajan, Nguyen, Koutsakos, Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19, Nat Med
Wang, Cao, Zhang, Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro, Cell Res
Wang, Hu, Hu, Clinical Characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China, JAMA
Wang, Pan, Zhang, Epidemiological and clinical features of 125 hospitalized patients with COVID-19 in Fuyang, Anhui, China, Int J Infect Dis
Zhang, Pang, Xue, Anti-SARS-CoV-2 virus antibody levels in convalescent plasma of six donors who have recovered from COVID-19, Aging
Zhong, Tang, Ye, Dong, The immunology of COVID-19: is immune modulation an option for treatment?, Lancet Rheumatol
Zhou, Yang, Wang, A pneumonia outbreak associated with a new coronavirus of probable bat origin, Nature
Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet
