Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance

Abstract

AimTo determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19.MethodsPeople 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.ResultsA 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.ConclusionsMore 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.

Breakthrough SARS-CoV-2 infections, morbidity, and seroreactivity following initial COVID-19 vaccination series and additional dose in patients with SLE in New York City

“…Patients with systemic lupus erythematosus (SLE) are at high risk of severe disease from COVID-19, due to inherent immune perturbations and frequent use of immunosuppressants. 1 , 2 These medications also affect clinical and serological responses to vaccination against SARS-CoV-2, with higher rates of breakthrough hospitalisations and attenuated seroreactivity in patients with immunosuppressed rheumatic disease after the initial vaccination series compared with controls. 3 , 4 , 5 Vaccine responses were investigated in New York City (NY, USA) between December, 2021, and February, 2022, during a surge of the highly infectious omicron (B.1.1.529) BA.1 variant of SARS-CoV-2, which resulted in a considerable increase in cases of and hospitalisations from COVID-19.…”

“…The rarity of severe clinical disease in vaccinated patients with SLE and COVID-19 exemplifies the considerable protective effect of vaccination in patients at high baseline risk, particularly compared with earlier in the pandemic. 1 , 2 There have been reports of decreased severity of infections with the omicron variant compared with the delta variant, but it has been difficult to ascertain the role of previous infection and vaccination in comparing virulence, and the omicron variant remains deadly in areas with less robust vaccination rates (eg, Hong Kong). 9 …”

Outcome of COVID-19 in patients with rheumatic and inflammatory diseases treated with mycophenolic acid: data from the French RMD COVID-19 cohort

“…An analysis of the French iRMD cohort showed that treatment with RTX could be considered an independent risk factor for the development of severe COVID-19, 7 which has since been confirmed by others. 12 Apart from RTX, other commonly prescribed immunosuppressive drugs, and in particular MPA, have been suspected to be linked with poor COVID-19 outcomes, even after gender and age adjusted analyses. 4 Raw data of the French RMD cohort suggested that the course of the COVID-19 infection was less favourable with MPA than that described with other targeted treatments, such as TNFα blockers, with the possibility of severe forms.…”

“…An analysis by the GRA in a population of lupus patients showed a similar result after adjustment for sex and age. 12 While the question of specifically protecting at-risk populations through isolation or vaccination arises, it is very important to conclude the direct impact of MPA, which is especially used in fragile patient populations.…”

Belimumab or anifrolumab for systemic lupus erythematosus? A risk-benefit assessment

“…Together, even long-term inhibition of BAFF does not seem to be associated with significant increases in the rates of infections, although exposures to plasmodium falciparum or other important (sub-)tropical parasites may have been rare in these studies. Interestingly, COVID-19 outcomes have been more favorable in the small subset of patients with SLE treated with belimumab ( 45 , 46 ).…”