COVID-19 infection among autoimmune rheumatic disease patients: Data from an observational study and literature review

Abstract

The impact of COVID-19 infection in patients with autoimmune/auto-inflammatory rheumatic diseases (AARD) under immunomodulatory treatment has been a focus of interest during the SARS-CoV-2 pandemic. In this observational study, demographic data, disease related features and comorbidities, COVID-19 manifestations and outcome, as well as antibody responses to SARS-CoV-2 were recorded among 77 consecutive patients with underlying AARD infected by SARS-CoV-2. Analysis of data was performed using univariate and multivariate models. Most patients (68.8%) had a mild COVID-19 course. The predominant clinical manifestations were fatigue (58.4%), low grade fever (45.4%) and upper respiratory tract symptoms (68.8%). About a quarter of patients required hospitalization (23.3%) and the mortality rate was 1.3%. Regarding COVID-19 severity, prior treatment with corticosteroids, mycophenolate mofetil or rituximab was more common in patients who developed a more serious disease course (60.0 vs 29.9%, p = 0.003, 40.0 vs 7.5%, p = 0.003, 10.0 vs 0.0%, p = 0.009, respectively). When disease related features and comorbidities were considered in multivariate models, older age and lung disease in the context of the AARD were found to be independent predictive factors for hospitalization (OR [95%]: 1.09 [1.03–1.15] and 6.43 [1.11–37.19]). Among COVID-19 related features, patients with shortness of breath and high-grade fever were more likely to get hospitalized (OR [95%]: 7.06 [1.36–36.57], 12.04 [2.96–48.86]), while anosmia was independently associated with lower hospitalization risk (OR [95%]: 0.09 [0.01–0.99]). Though the majority of AARD patients displayed a mild COVID-19 course, certain underlying disease features and COVID-19 related manifestations should prompt alertness for the physician to identify patients with AARD at high risk for severe COVID-19 and need for hospitalization.

Better outcomes of COVID-19 in vaccinated compared to unvaccinated patients with systemic rheumatic diseases

“…Of note, hospitalisation and death rates in our unvaccinated patients were comparable to those described by a previous observational study examining COVID-19 outcomes in patients with SRD in our country. 14 As shown in figure 1, and in accordance with other reports, 8 9 about half of our patients got infected during the first 10 weeks after the second vaccine dose. Although it is well known that vaccine efficacy declines overtime, therefore most breakthrough infections would be expected to occur closer to the end of the observational period; it should be noted that temporal fluctuations of the viral load in the community, during spring 2021 in Greece, 15 explain our results.…”

COVID-19 and Autoimmune/Autoinflammatory Rheumatic Disease Patients: Lessons Learned and Questions Anticipating Answers

“…Predisposing factors for severe disease, hospitalisation, and COVID-19 related death of AARD patients were similar to the ones described in our work. 8 – 12 Furthermore, the same therapeutic agents which were described in our study led AARD patients with COVID-19 to severe outcome and death. Mortality of AARD patients from COVID-19 was also found to be comparable to the one in the general population 13 .…”

“…Our group conducted a prospective study exploring COVID-19 manifestations, outcomes, as well as antibody responses to SARS-CoV-2 among infected AARD patients. 8 It was shown that the majority of patients (68.8%) experienced a mild disease course, about a quarter (23.4%) required inpatient treatment, and the mortality rate was 1.2%. Regarding symptomatology, fatigue, low grade fever, respiratory, and musculoskeletal complaints were predominant in the clinical picture of these patients.…”

Protracted severe COVID-19 pneumonia following rituximab treatment: caution needed

“…The outcomes of COVID-19 in patients treated with biologic agents is a subject of intense investigation and evidence is accumulating rapidly. Data from the COVID-19 Global Rheumatology Alliance, among other, indicated that patients under RTX may carry an increased risk of serious disease [ 1 , 2 ]; this was confirmed recently in several registries [ 3 , 4 ] fueling concerns regarding the use of B cell depleting agents during the pandemic, especially in patients not yet vaccinated against COVID-19. Herein, we present a rare case of severe, protracted COVID-19 pneumonia in a patient with MCTD who was infected a few days following RTX treatment with a fatal outcome.…”