CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory rheumatism or autoimmune diseases

Abstract

IntroductionAutoimmune/inflammatory rheumatic diseases (AIRDs) patients might be at-risk of severe COVID-19. However, whether this is linked to the disease or to its treatment is difficult to determine. This study aimed to identify factors associated with occurrence of severe COVID-19 in AIRD patients and to evaluate whether having an AIRD was associated with increased risk of severe COVID-19 or death.Materials and methodsTwo databases were analyzed: the EDS (Entrepôt des Données de Santé, Clinical Data Warehouse), including all patients followed in Paris university hospitals and the French multi-center COVID-19 cohort [French rheumatic and musculoskeletal diseases (RMD)]. First, in a combined analysis we compared patients with severe and non-severe COVID-19 to identify factors associated with severity. Then, we performed a propensity matched score case–control study within the EDS database to compare AIRD cases and non-AIRD controls.ResultsAmong 1,213 patients, 195 (16.1%) experienced severe COVID-19. In multivariate analysis, older age, interstitial lung disease (ILD), arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory diseases, and treatment with corticosteroids or rituximab were associated with increased risk of severe COVID-19. Among 35,741 COVID-19 patients in EDS, 316 having AIRDs were compared to 1,264 Propensity score-matched controls. AIRD patients had a higher risk of severe COVID-19 [aOR = 1.43 (1.08–1.87), p = 0.01] but analysis restricted to rheumatoid arthritis and spondyloarthritis found no increased risk of severe COVID-19 [aOR = 1.11 (0.68–1.81)].ConclusionIn this multicenter study, we confirmed that AIRD patients treated with rituximab or corticosteroids and/or having vasculitis, auto-inflammatory disease, and sarcoidosis had increased risk of severe COVID-19. Also, AIRD patients had, overall, an increased risk of severe COVID-19 compares general population.

Infectious Complications of Pulmonary Sarcoidosis

“…It seems that the risk only affects patients with a corticosteroid dose ≥10 mg/day [53]. Interestingly, treatment with leflunomide and methotrexate was significantly associated with a better outcome [49]. The TNF-alpha antagonists do not seem to be associated with severe COVID-19 in this and other studies [44,49,53].…”

“…For example, the study conducted by Chevalier et al analyzed 1213 patients with autoimmune/inflammatory rheumatic diseases with COVID-19 from two French national databases: the EDS (Entrepôt des Données de Santé, including all patients followed in Paris university hospitals) and the French multicenter COVID-19 cohort French Rheumatic and Musculoskeletal diseases (RMDs). Among the 64 patients with both sarcoidosis and COVID-19, the study found that sarcoidosis was an independent factor for severe COVID-19 (i.e., ICU admission and/or death) in the multivariate analysis (aOR = 5.19, 2.15-12.3), along with other factors, such as older age, interstitial lung disease, arterial hypertension, and obesity [49].…”

“…Immunosuppressive medications may be associated with the risk of severe sarcoidosis. In the study by Chevalier et al, treatment with corticosteroids (aOR 2.47 (1.58-3.87)) or rituximab (aOR 3.32 (1.45-7.49)) was an independent factor of severe COVID-19 [49]. It seems that the risk only affects patients with a corticosteroid dose ≥10 mg/day [53].…”

“…It is important to note that all the studies discussed here regard the severity of enrolled patients at the onset of the pandemic, before the introduction of vaccines and the emergence of new, less severe variants. Several series studies with small numbers of patients with sarcoidosis and COVID-19 have reported significantly high rates of ICU admission and mortality, reaching 37.5% and 17.2%, respectively [44][45][46][47][48][49]. These series had selection biases, as the research was primarily conducted in hospital-based and tertiary centers, potentially leading to the inclusion of a greater proportion of hospitalized COVID-19 patients and individuals with more severe sarcoidosis who had additional comorbidities and were undergoing immunosuppressive treatments.…”

Characteristics of patients with sarcoidosis who referred to a pulmonologist during the COVID-19 pandemic

“…Случай смерти от COVID-19 был ранее описан отечественными авторами у пациента, страдавшего в течение трех лет саркоидозом со стабильным течением, но с гипертонической болезнью, концентрической гипертрофией миокарда, хронической ишемической болезнью сердца со стенозирующим атеросклерозом коронарных артерий и кардиосклерозом [20]. Наблюдательные исследования, проведенные в различных медицинских центрах, в большинстве случаев свидетельствовали о благоприятном течении заболеваний при их сочетании, невысокой распространенности COVID-19 среди пациентов с саркоидозом, а ключевыми факторами риска тяжелого течения COVID-19 для пациентов с саркоидозом были нарушение функции легких, внелегочные поражения, сопутствующие заболевания, развившиеся до пандемии, и продолжаю щаяся иммуносупрессивная терапия саркоидоза [21][22][23].…”