Clinical course and outcomes of COVID-19 in rheumatic disease patients: a case cohort study with a diverse population

Arleo, Timothy; Tong, David; Shabto, Julie M.; O’Keefe, Ghazala; Khosroshahi, Arezou

doi:10.1007/s10067-021-05578-x

Cited by 20 publications

(66 citation statements)

References 17 publications

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“…In multivariate regression models, age, comorbidities as well as GC therapy prior to the SARS-CoV-2 infection remained associated with the risk of hospitalization [31]. Other studies and case reports of patients with immune-mediated inflammatory diseases are in line with these results and point to similar observations (Table 1): the use of GCs is higher among hospitalized patients, and chronic oral GC use is associated with a higher risk of hospitalization due to COVID-19 in this population [32][33][34][35]. In contrast, other studies and case reports of patients with rheumatic diseases showed no direct and significant relation between GC use and the risk of a severe course of disease [36][37][38].…”

Section: Risk In Exogenous Glucocorticoid Excesssupporting

confidence: 73%

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Vogel

Reincke

2021

Rev Endocr Metab Disord

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Patients with endogenous or exogenous glucocorticoid (GC) excess exhibit a range of side effects, including an increased risk of infections. Via both mechanism, immune impairments and cardiometabolic concomitant diseases, patients with GC excess could be at increased risk for COVID-19. The impact on incidence and outcome of a SARS-CoV-2 infection in this population are not yet completely clear. This review aims to compile the data available to date and to discuss the existing literature on this topic. Further we highlight potential effects of SARS-CoV-2 on the hypothalamic-pituitary-adrenal axis as well as the influence of endogenous or exogenous GC excess on SARS-CoV-2 mRNA vaccination. There is growing evidence suggesting an increased risk of infection and severe outcome in patients with high-dose GC therapy after contracting SARS-CoV-2. The few data and case reports on patients with endogenous GC excess and SARS-CoV-2 infection point in a similar direction: chronic GC excess seems to be associated with an unfavorable course of COVID-19. Whether this is mainly a primary immune-mediated effect, or also triggered by the many GC-associated comorbidities in this population, is not yet fully understood. Patients with endogenous or exogenous GC excess should be considered as a vulnerable group during the SARS-CoV-2 pandemic. Regardless of the cause, vaccination and consistent surveillance and control of associated comorbidities are recommended.

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Section: Risk In Exogenous Glucocorticoid Excesssupporting

confidence: 73%

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Vogel

Reincke

2021

Rev Endocr Metab Disord

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“…Among different races, due to the influence of genetics, survival environment or life styles, slight or apparent discrepancies exist in the disease manifestations. The proportion of RADs patients from different ethnic groups varies in the COVID-19 pandemic ( 30 , 31 , 33 , 34 ). In a race-focused study on 1,324 patients, by using multivariable models, researchers compared the clinical manifestations among African American, Latinx, Asian, and White patients.…”

Section: Influencing Factors Of Rads Complicated With Covid-19mentioning

confidence: 99%

“…In addition, the effects of TNF inhibitors and tocilizumab on clinical epidemiology have also been reported. Patients receiving adalimumab or infliximab treatment had a reduced risk of COVID-19 infection ( 19 ), and monotherapy of TNF-inhibitor prior to COVID-19 infection may reduce the COVID-19-related hospitalization or severity ( 12 , 25 , 31 , 36 ). Treatment of tocilizumab has been proven to ensure stability of vascular permeability and myocardial function in RA patients infected with COVID-19 ( 59 , 60 ), and also reduce the COVID-19 associated mortality and levels of inflammatory indicators ( 61 , 62 ).…”

Section: Treatmentsmentioning

confidence: 99%

“…Male and female patients behave differently in COVID-19 outbreak. The majority of RADs patients infected with COVID-19 were female (4,5,15,18,20,22,23,25,(28)(29)(30)(31)(32), generally exceeding 60%, with an average of 70.86% (Figure 2). The overall mortality during COVID-19 development was higher in female RADs patients (11), which is different from the situation in non-RAD population that male accounts for a greater proportion.…”

Section: Age and Gendermentioning

confidence: 99%

“…In view of this, during the COVID-19 epidemic, rheumatologists paid considerable attention to the adverse effects of comorbidities on RADs patients. Overall, after data integration of 14 articles retrieved (4,5,15,18,20,(22)(23)(24)(25)(28)(29)(30)(31)(32), the most common comorbidities in RADs patients infected with COVID-19 were cardiovascular diseases (37.34%), endocrine diseases (25.02%) and respiratory diseases (23.45%) (Figure 2), which were mainly attributed to hypertension, diabetes, chronic obstructive pulmonary disease and asthma, respectively. Renal diseases and hepatic diseases also account for a small proportion (11.57 and 6.14%, respectively).…”

Section: Comorbiditiesmentioning

confidence: 99%

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Epidemiology and Clinical Management of Rheumatic Autoimmune Diseases in the COVID-19 Pandemic: A Review

2021

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The coronavirus disease 2019 (COVID-19) has been in pandemic for more than 1 year, with serious negative effects produced worldwide. During this period, there have been a lot of studies on rheumatic autoimmune diseases (RADs) combined with COVID-19. The purpose of this study is to review and summarize these experiences. Pubmed, Web of science, Embase and the Cochrane library were searched from January 15, 2020 to July 15, 2021 using RADs and COVID-19 related keywords. Based on a comprehensive review of studies covering 16 countries, the prevalence of COVID-19 does not necessarily increase in RADs patients compared to the general population. In RADs population infected with COVID-19, a high proportion of female patients (54.44~95.2%), elderly patients (≥50y, 48~75.88%), and patients with pre-existing comorbidities (respiratory, 4.8~60.4%; endocrine, 8.52~44.72%; cardiovascular, 15.7~64.73%) were observed, although, this does not appear to have a decisive effect on disease severity. Many anti-rheumatic treatments have been extensively evaluated for their efficacy of treating COVID-19 in RADs patients, with TNF-α inhibitors and IL-6 receptor antagonist receiving more positive reviews. However, there is no conclusive information for most of the therapeutic regimens due to the lack of high-level evidence. Inflammatory markers or neutrophil-lymphocyte-ratio may be applied as indicators for clinical prognosis or therapeutic regimens adjustment. Thus, more research is still needed to address the prevalence, treatment, and clinical monitoring of RADs patients in COVID-19 pandemic.

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Effect of Immunosuppressive or Immunomodulatory Agents on Severe COVID‐19 Outcomes: A Population‐Based Cohort Study

Marozoff,

Tan,

et al. 2023

ACR Open Rheumatology

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ObjectiveWe estimated the association between immunosuppressive and immunomodulatory agent (IIA) exposure and severe COVID‐19 outcomes in a population‐based cohort study.MethodsParticipants were 18 years or older, tested positive for SARS‐CoV‐2 between February 6, 2020, and August 15, 2021, and were from administrative health data for the entire province of British Columbia, Canada. IIA use within 3 months prior to positive SARS‐CoV‐2 test included conventional disease‐modifying antirheumatic drugs (antimalarials, methotrexate, leflunomide, sulfasalazine, individually), immunosuppressants (azathioprine, mycophenolate mofetil/mycophenolate sodium [MMF], cyclophosphamide, cyclosporine, individually and collectively), tumor necrosis factor inhibitor (TNFi) biologics (adalimumab, certolizumab, etanercept, golimumab, infliximab, collectively), non‐TNFi biologics or targeted synthetic disease‐modifying antirheumatic drugs (tsDMARDs) (rituximab separately from abatacept, anakinra, secukinumab, tocilizumab, tofacitinib and ustekinumab collectively), and glucocorticoids. Severe COVID‐19 outcomes were hospitalizations for COVID‐19, ICU admissions, and deaths within 60 days of a positive test. Exposure score–overlap weighting was used to balance baseline characteristics of participants with IIA use compared with nonuse of that IIA. Logistic regression measured the association between IIA use and severe COVID‐19 outcomes.ResultsFrom 147,301 participants, we identified 515 antimalarial, 573 methotrexate, 72 leflunomide, 180 sulfasalazine, 468 immunosuppressant, 378 TNFi biologic, 49 rituximab, 144 other non‐TNFi biologic or tsDMARD, and 1348 glucocorticoid prescriptions. Risk of hospitalizations for COVID‐19 was significantly greater for MMF (odds ratio [95% CI]): 2.82 [1.81‐4.40], all immunosuppressants: 2.08 [1.51‐2.87], and glucocorticoids: 1.63 [1.36‐1.96], relative to nonuse. Similar outcomes were seen for ICU admission and MMF: 2.52 [1.34‐4.74], immunosuppressants: 2.88 [1.73‐4.78], and glucocorticoids: 1.86 [1.37‐2.54]. Only glucocorticoids use was associated with a significant increase in 60‐day mortality: 1.58 [1.21‐2.06]. No other IIAs displayed statistically significant associations with severe COVID‐19 outcomes.ConclusionCurrent use of MMF and glucocorticoids were associated with an increased risk of severe COVID‐19 outcomes compared with nonuse. These results emphasize the variety of circumstances of patients taking IIAs.

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Clinical course and outcomes of COVID-19 in rheumatic disease patients: a case cohort study with a diverse population

Cited by 20 publications

References 17 publications

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Endocrine risk factors for COVID-19: Endogenous and exogenous glucocorticoid excess

Epidemiology and Clinical Management of Rheumatic Autoimmune Diseases in the COVID-19 Pandemic: A Review

Effect of Immunosuppressive or Immunomodulatory Agents on Severe COVID‐19 Outcomes: A Population‐Based Cohort Study

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