The main modality in autoimmune disease is a long-term immunosuppressant treatment aiming to control disease progression and increase patient life expectancy. This scoping review aims to evaluate the effect of immunosuppressant treatment in autoimmune patients with COVID-19 on clinical outcomes and disease progression. This scoping review was conducted following the PRISMA extension for scoping review (PRISMA-ScR) guidelines. The Pubmed and Science Direct databases are used to find articles that match the study objectives. Thirteen articles met the inclusion criteria, and all of them were classified as observational studies. Most immunosuppressant treatments are the disease-modifying anti-rheumatic drugs (DMARD) and glucocorticoids. The highest number of autoimmune patients with rheumatoid arthritis (RA) was 43.4%, systemic lupus erythematosus (SLE) 13.6%, and others was 43%. Autoimmune patients with COVID-19 taking immunosuppressant medications, particularly glucocorticoids, significantly increased the risk of hospitalization and the use of ventilators. However, there was no mention of the dosage and duration of immunosuppressant therapy in most of the studies. In general, the use of immunosuppressant drugs was not associated with an increased risk of COVID-19 infection and mortality compared with the general population. Increasing age and comorbidities were associated with poor clinical outcomes. In conclusion, autoimmune patients with COVID-19 who are taking immunosuppressant therapy particularly glucocorticoid exacerbate clinical outcomes. Periodic clinical monitoring and appropriate pharmacological interventions are required in autoimmune patients with COVID-19 to improve clinical outcomes and prevent death.Keywords: Autoimmune, COVID-19, Immunosuppressant, Clinical outcome.
The impact of immunosuppressant therapy in COVID-19 patients with autoimmune rheumatic disease remains unclear based on previous studies. Here, we reviewed the clinical evidence to evaluate COVID-19 patients with rheumatic disease outcomes, which previously used immunosuppressant therapy to control the disease. We used PubMed and Science Direct database to search literature up to April 2021 for publications with confirmed COVID-19 infection with rheumatic disease. The outcomes of this review were the infection rate of COVID-19 and the rate of hospitalization, ICU admission, and mortality. A total of 16 articles were included in this review. The overall rates of COVID-19 infection in patients with autoimmune rheumatic disease did not differ from the general population. Rheumatic disease patients who previously used hydroxychloroquine showed a similar infection risk of COVID-19 with those who did not use hydroxychloroquine. Furthermore, immunosuppressant therapies were associated with poor clinical outcomes, increase risk of hospitalization, ICU admission, and mortality, particularly in patients with comorbidities. The use of bDMARD, such as TNF-α inhibitor, showed a protective effect to reduce the risk of hospitalization and mortality. The administration of immunosuppressant therapy must be closely monitored in rheumatic disease patients due to unfavorable outcomes. More studies are urgently required to map risk factors of clinical outcomes with the specific immunosuppressant therapy and specific rheumatic disease.
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