Prevalence, admission rates and hypoxia due to COVID-19 in patients with rheumatic disorders treated with targeted synthetic or biologic disease modifying antirheumatic drugs or methotrexate: a nationwide study from Iceland

Björnsson, Aron Hjalti; Gröndal, Gerður; Kristjánsson, Már; Jónsdóttir, Thórunn; Löve, Thorvarður Jón; Guðbjörnsson, Björn

doi:10.1136/annrheumdis-2020-219564

Cited by 9 publications

(8 citation statements)

References 5 publications

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“…4,9,37 Methotrexate as a risk factor has not been studied in cancer patients, but findings for low-dose methotrexate in patients with rheumatologic conditions have been mixed. 38,39 Despite the biologic rationale for poor COVID-19 outcomes in patients receiving venetoclax or methotrexate, we did not find a consistent association across other outcomes. For example, there was no increased risk of severe COVID-19 in hospitalized patients receiving these therapies.…”

Section: Discussioncontrasting

confidence: 67%

COVID‐19 outcomes in patients with cancer: Findings from the University of California health system database

et al. 2022

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Background The interaction between cancer diagnoses and COVID‐19 infection and outcomes is unclear. We leveraged a state‐wide, multi‐institutional database to assess cancer‐related risk factors for poor COVID‐19 outcomes. Methods We conducted a retrospective cohort study using the University of California Health COVID Research Dataset, which includes electronic health data of patients tested for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) at 17 California medical centers. We identified adults tested for SARS‐CoV‐2 from 2/1/2020–12/31/2020 and selected a cohort of patients with cancer. We obtained demographic, clinical, cancer type, and antineoplastic therapy data. The primary outcome was hospitalization within 30d after the first positive SARS‐CoV‐2 test. Secondary outcomes were SARS‐CoV‐2 positivity and severe COVID‐19 (intensive care, mechanical ventilation, or death within 30d after the first positive test). We used multivariable logistic regression to identify cancer‐related factors associated with outcomes. Results We identified 409,462 patients undergoing SARS‐CoV‐2 testing. Of 49,918 patients with cancer, 1781 (3.6%) tested positive. Patients with cancer were less likely to test positive (RR 0.70, 95% CI: 0.67–0.74, p < 0.001). Among the 1781 SARS‐CoV‐2‐positive patients with cancer, BCR/ABL‐negative myeloproliferative neoplasms (RR 2.15, 95% CI: 1.25–3.41, p = 0.007), venetoclax (RR 2.96, 95% CI: 1.14–5.66, p = 0.028), and methotrexate (RR 2.72, 95% CI: 1.10–5.19, p = 0.032) were associated with greater hospitalization risk. Cancer and therapy types were not associated with severe COVID‐19. Conclusions In this large, diverse cohort, cancer was associated with a decreased risk of SARS‐CoV‐2 positivity. Patients with BCR/ABL‐negative myeloproliferative neoplasm or receiving methotrexate or venetoclax may be at increased risk of hospitalization following SARS‐CoV‐2 infection. Mechanistic and comparative studies are needed to validate findings.

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Section: Discussioncontrasting

confidence: 67%

COVID‐19 outcomes in patients with cancer: Findings from the University of California health system database

et al. 2022

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“…As regards to hospitalization rates, there are three nation-wide studies from Sweden[14], Denmark [20] and Iceland [21], in line with our findings, while two metaanalyses [4,5] report different results on this matter. This could be interpreted in light of several differences between countries, such as local guidelines, intensity of pandemic wave, saturation level of health care system, access to healthcare facilities and other confounders [22].…”

Section: Discussionsupporting

confidence: 88%

Different Covid-19 Outcomes Among Systemic Rheumatic Diseases: A Nation-wide Cohort Study

Bournia

Fragoulis

Mitrou

et al. 2022

Preprint

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Background: Nationwide data at a country level on Covid-19 in unvaccinated patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are scarce. Methods: By interlinking data from national electronic registries, covering nearly 99% of the Greek population (approximately 11,000,000), between March 2020 and February 2021, when vaccination became available, we recorded confirmed infections and Covid-19-associated hospitalizations and deaths in essentially all adult patients with RA, AS, PsA, SLE, and SSc under treatment (n=74,970, median age of 67.5, 51.2, 58.1, 56.2, 62.2 years, respectively) and in individually matched (1:5) on age, sex, and region of domicile random comparators from the general population. Results: Binary logistic regression analysis after adjusting for age, sex and biologic agents, revealed that RA, PsA, SLE and SSc, but not AS patients, had significantly higher risk of infection (by 43%, 25%, 20% and 49%, respectively), and hospitalization for Covid-19 (by 81%, 56%, 94%, and 111%, respectively), possibly due, at least in part, to increased testing and lower threshold for admission. Patients with RA and SSc had indeed higher Covid-19 associated mortality rates [OR:1.86 (95% CI 1.37 to 2.52) and OR:2.90 (95% CI 0.97 to 8.67), respectively] compared to the general population. Each additional year of age increased the risk of hospitalization for Covid-19 by 3% (OR 1.030, 95% CI: 1.028 to 1.034) and the risk of Covid-19 related death by 8% (OR 1.08, 95% CI: 1.07 to 1.09), independently of gender, systemic rheumatic disease, and biologic agents. A further analysis using AS patients as the reference category, adjusting again for age, sex and use of biologic agents showed that patients with SSc had increased mortality (OR: 6.90, 95% CI: 1.41 to 33.72), followed by SLE (OR: 4.05 95% CI: 0.96 to 17.12) and RA patients (OR: 3.65, 95% CI: 1.06 to 12.54), whereas PsA patients had comparable mortality risk with AS patients. Conclusion: Comparing to the general population, Covid-19 may have a more severe impact in real-world patients with systemic rheumatic disease. Covid-19 related mortality is increased in subgroups of patients with specific rheumatic diseases, especially in older ones, underscoring the need for priority vaccination policies and access to targeted treatments.

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“…4,9,34 Methotrexate as a risk factor has not been studied in cancer patients, but findings for low-dose methotrexate in patients with rheumatologic conditions have been mixed. 35,36 Despite the biologic rationale for poor COVID-19 outcomes in patients receiving venetoclax or methotrexate, we did not find a consistent association across other outcomes. For example, there was no increased risk of severe COVID-19 in hospitalized patients receiving these therapies.…”

Section: Discussioncontrasting

confidence: 67%

COVID-19 Outcomes in Patients with Cancer: Findings from the University of California Health System Database

Kwon

Pico

Nguyen

et al. 2021

Preprint

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Background: Patients with cancer are at risk for poor COVID-19 outcomes. We aimed to identify cancer-related risk factors for poor COVID-19 outcomes. Patients and Methods: We conducted a retrospective cohort study using the University of California Health COVID Research Data Set. This database includes prospectively-collected, electronic health data of patients who underwent testing for SARS-CoV-2 at seventeen California medical centers. We identified adult patients tested for SARS-CoV-2 between February 1, 2020 and December 31, 2020, and selected a cohort of patients with cancer using diagnostic codes. We obtained demographic, comorbidity, laboratory, cancer type, and antineoplastic therapy data. The primary outcome was hospitalization within 30 days after first positive SARS-CoV-2 test. Secondary outcomes were SARS-CoV-2 positivity and composite endpoint for severe COVID-19 (intensive care, mechanical ventilation, or death within 30 days after first positive test). We used multivariable logistic regression to identify cancer-related factors associated with outcomes. Results: We identified 409,462 patients undergoing SARS-CoV-2 testing. Of 49,918 patients with cancer, 1,781 (3.6%) tested positive. Patients with cancer were less likely to test positive (OR 0.69, 95%CI 0.66-0.73, P<0.001). BCR-ABL-negative myeloproliferative neoplasms (polycythemia vera, essential thrombocythemia, and primary myelofibrosis) (OR 2.51, 95%CI 1.29-4.89, P=0.007); venetoclax (OR 3.63, 95%CI 1.02-12.92, P=0.046); methotrexate (OR 3.65, 95%CI 1.17-11.37, P=0.026); Asian race (OR 1.92, 95%CI 1.23-2.98, P=0.004); and Hispanic/Latino ethnicity (OR 1.96, 95%CI 1.41-2.73, P<0.001) were associated with increased hospitalization risk. Among 388 hospitalized patients with cancer and COVID-19, cancer type and therapy type were not associated with severe COVID-19. Conclusions: In this large, diverse cohort of Californians, cancer was not a risk factor for SARS-CoV-2 positivity. Patients with BCR/ABL-negative myeloproliferative neoplasm and patients receiving methotrexate or venetoclax may be at an increased risk of hospitalization following SARS-CoV-2 infection. Further mechanistic and comparative studies are needed to explain and confirm our findings.

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Prevalence, admission rates and hypoxia due to COVID-19 in patients with rheumatic disorders treated with targeted synthetic or biologic disease modifying antirheumatic drugs or methotrexate: a nationwide study from Iceland

Cited by 9 publications

References 5 publications

COVID‐19 outcomes in patients with cancer: Findings from the University of California health system database

COVID‐19 outcomes in patients with cancer: Findings from the University of California health system database

Different Covid-19 Outcomes Among Systemic Rheumatic Diseases: A Nation-wide Cohort Study

COVID-19 Outcomes in Patients with Cancer: Findings from the University of California Health System Database

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