COVID‐19 infection in patients with connective tissue disease: A multicity study in Hubei province, China

Ye, Cong; Zhong, Jixin; Cai, Shaozhe; Li, Dong; Li, Chuanjing; Hou, Xiaoqiang; Chen, Xiaoqi; Zhang, Anbing; Chen, Wenli; Dong-chu, HE; Zhou, Tao; Shang, Guilian; Chu, Aichun; Li, Huiling; Liu, Qihuan; Wu, Bin; Yu, Xiaoyan; Peng, Tao; Wen, Cheng; Huang, Gang; Huang, Hao; Huang, Qin; Su, Lin‐Chong; Chen, Wenping; Yang, Huiqin; Dong, Lingli

doi:10.1002/mco2.56

Cited by 7 publications

(9 citation statements)

References 32 publications

(36 reference statements)

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“…The main presenting symptoms in the HCQ group were cough in 45 patients (84.9%) and fever in 38 patients (71.7%), while cough was the main presenting symptom in the second group (75.6 %). These findings are in line with the findings of studies by Ye et al 2021 (11) and Pham et al 2021 (15) which showed that fever and cough were the most common symptoms in both groups of their studies. Rhinorrhea was significantly presented among 2nd group cases (P=0.015), this finding is similar to what was reported by Pham et al 2021 (15) in their study.…”

Section: Discussionsupporting

confidence: 92%

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Role of Hydroxychloroquine in Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients during COVID-19 Pandemic

Elnagdy

Sobh²,

Elegezy³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: Antimalarial drugs including Hydroxychloroquine (HCQ) and chloroquine have been demonstrated to be associated with anti-inflammatory actions in different connective tissue diseases (CTD) as rheumatoid arthritis (RA) and Systemic Lupus Erythematosus (SLE). One of the points of interest was the emergent antiviral effect of these drugs against Covid-19 infection. However, this antiviral effect is still debatable. Objective: The objective was to study HCQ effects on the severity and outcome of COVID-19 infection in patients with RA and SLE. Patients and Methods: A total of 94 cases diagnosed as RA and SLE with COVID-19 infection were comprised in the study and were categorized into 2 groups: the first group included patients who were receiving HCQ treatment before infection, and the second group included patients who were not receiving HCQ before. Clinical, laboratory, and radiological findings as well as the outcome of patients were assessed to compare the severity of COVID-19 infection in both groups. Results: Demographic data showed higher female predominance. Fever, cough, rhinorrhea, and myalgia were observed in both groups with no significant variation except for rhinorrhea. D-dimer was significantly increased in the first group. Decreased oxygen saturation, need for mechanical ventilation, radiological changes suggestive of COVID-19 infection, and acute kidney injury (AKI) were more observed in the HCQ group with statistical significance. Conclusion: HCQ administration was not associated with less severe infection or better outcomes in RA and SLE patients infected with COVID-19.

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Section: Discussionsupporting

confidence: 92%

“…Infection with COVID-19 might be very extensive in cases with CTD. Despite the lower possibility of severe COVID-19 infections in patients receiving HCQ and/or glucocorticoid therapy with lowto medium-dose, immunosuppressive agents should be used with extra caution due to their dysregulated immune response (11) .…”

Section: Introductionmentioning

confidence: 99%

Role of Hydroxychloroquine in Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients during COVID-19 Pandemic

Elnagdy

Sobh²,

Elegezy³

et al. 2022

The Egyptian Journal of Hospital Medicine

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“…In line with these results, treatment with higher dosages of GC in patients with rheumatic diseases has been shown as an independent risk factor associated with COVID-19-related death [41,42]. In contrast again, there are studies that do not see any significant correlation in multivariable adjusted analyses [43], or even one report that suggests reduced disease progression from mild to critical conditions under low-to medium-dose GC treatment (5-15 mg/day prednisone) [44]. However, the latter study consisted of only 22 patients with GC therapy.…”

Section: Risk In Exogenous Glucocorticoid Excessmentioning

confidence: 74%

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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“…It is well accepted that COVID-19 patients with comorbidities are potentially very high risk for death if they progress to oxygen desaturation and are hospitalized for complications of COVID-19. [ 11 12 13 ] However, the mortality rate of the patients under the review was surprisingly low even in the very limited health care setting. Moreover, 90% of our patients were unvaccinated.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, high mortality rate was seen in the patients with age more than 60 years, diabetes, hypertension, cardiovascular diseases (CVD), chronic respiratory diseases including asthma and chronic obstructive disease (COPD), HIV, connective tissue disorders and hence they are high-risk groups for severe COVID-19 disease. [ 11 12 13 ] It would be more rational to consider remdesivir initiation among the high-risk COVID-19 patients during viral phase.…”

Section: Introductionmentioning

confidence: 99%

Early initiation of remdesivir and its effect on oxygen desaturation: A clinical review study among high-risk COVID-19 patients in Myanmar

Aye

Myat²,

Tun³

et al. 2022

Journal of Family Medicine and Primary Care

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Background: Although Remdesivir has been evaluated for the treatment of coronavirus disease 2019 (COVID-19), few study has yet shown effective mortality reduction. It might be because, in almost all those studies, remdesivir therapy was started beyond 7 th days from the onset of symptoms when the active viral replications have already gone. Methods: This study reviewed the effectiveness of early remdesivir therapy during viral phase of COVID-19 and safety of its administration at home or community care during the outbreak of COVID-19 from July to September 2021 in Myanmar. We retrospectively reviewed clinical records of 204 high risk COVID-19 patients who had received remdesivir therapy within 7 days from the onset of illness and before oxygen desaturation. Findings: All patients received remdesivir therapy according to standard five days course of 200 mg loading dose on day 1, followed by 100 mg daily for up to 4 additional days. Out of 204 patients, 60.75% (124/204) were aged 60 years and above with comorbidity; 21.1% (43/204) aged under 60 years with comorbidity and 18.1% (37/204) were aged more than 60 years old without comorbidity. The patients who received RDSV therapy within 1-4 days and within 5-7 days were 50.5% (103/204) and 49.5% (101/204) respectively. All patients survived to 21 days without ICU admission or mechanical ventilation. Eighty six percent of patients had no hypoxia and only five percent had moderate to severe hypoxia, requiring oxygen. Those who received RDSV therapy within 1 to 4 days from the onset of symptoms had significantly lower rate of hypoxia compared to those who received remdesivir therapy on 5 to 7 days. After RDSV therapy, increased lymphocyte count and decreased CPR were observed in 74.5% (152/204) and 52.9% (108/204) of the patients respectively. There was no report of major adverse events. Conclusion: Remdesivir, if given within first 4 days from the onset of symptoms, is the most effective strategy for prevention of oxygen desaturation, further progression of COVID-19 and death although it is still beneficial if given later, days 5 to 7. It is a safe drug to be prescribed in hospital at home care. It may be cost-benefit if high-risk group of patients with COVID-19 were selected for early remdesivir therapy in the community.

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COVID‐19 infection in patients with connective tissue disease: A multicity study in Hubei province, China

Cited by 7 publications

References 32 publications

Role of Hydroxychloroquine in Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients during COVID-19 Pandemic

Role of Hydroxychloroquine in Rheumatoid Arthritis and Systemic Lupus Erythematosus Patients during COVID-19 Pandemic

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

Early initiation of remdesivir and its effect on oxygen desaturation: A clinical review study among high-risk COVID-19 patients in Myanmar

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