Response to ‘Correspondence on ‘Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis’’ by Gremeseet al

Abstract

Response to 'Correspondence on 'Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis'' by Gremese et alWe thank Gremese et al 1 for their suggestion in our research article entitled 'Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis'. 2 Their recent work described that lung perfusion CT scan identified perfusion abnormalities such as hyperperfusion around areas of hypoperfusion (leukothrombosis) in patients with COVID-19associated pneumonia, even without respiratory distress. 3 They also demonstrated that in one of these patients, lung perfusion CT scan showed an improvement in parameters related to the perfusion abnormalities according to clinical improvement after starting treatments with enoxaparin and interleukin-6 inhibitor, without steroids. 1 They suggested that COVID-19-associated pneumonia might be attributed to hyperinflammation and/or leucothrombosis.In our study, meta-regression analysis demonstrated that glucocorticoid (GC) use was significantly associated with a greater prevalence of COVID-19 in patients with autoimmune diseases (ADs). In terms of clinical outcomes, overall hospitalisation and mortality rates in patients with ADs were 35.2% (95% CI: 23.0%-49.7%) and 6.6% (95% CI: 3.6%-11.8%), respectively. In contrast, our subgroup meta-analysis according to medical therapies showed that hospitalisation and mortality rates in patients with ADs exposed to GCs were 56.0% (95% CI: 46.2%-65.3%) and 14.7% (95% CI: 10.2%-20.6%), respectively, suggesting that GCs would increase the risk of these severe outcomes of COVID-19. Meta-regression analysis also showed a higher proportion of GC use tended to be associated with a higher rate of hospitalisation (regression coefficient: 0.011, 95% CI: −0.0003 to 0.022, p=0.056) and death (regression coefficient: 0.011, 95% CI: −0.001 to 0.022, p=0.075), although this was not statistically significant. 2 The patients included in our study were likely on GCs for some time for their underlying ADs. Thus, our data showed the harmful effects of 'chronic' GC use on the risk of SARS-CoV-2 infection and severe COVID-19. As stated in the correspondence by Gremese et al, 1 the evidence regarding the effectiveness and safety of therapeutic GC use for patients with COVID-19 remains controversial. 4 5 The results of our study do not preclude the use of GCs such as dexamethasone for COVID-19-associated pneumonia and cytokine release syndrome in patients with ADs. The findings of Gremese et al are interesting and we agree that further investigations of the pathogenesis of COVID-19associated pneumonia and the role of GCs as therapeutics in patients with ADs in such a setting are warranted. 1

SARS-CoV-2 Proteome Harbors Peptides Which Are Able to Trigger Autoimmunity Responses: Implications for Infection, Vaccination, and Population Coverage

“…This means that predisposition to such genetic history can act as a powerful trigger for the immune system to respond beyond normal (31). It has also been revealed that the risk of COVID-19 is higher in the patients suffering from autoimmune diseases (32).…”

Asthma, from mild to severe, is an independent prognostic factor for mild to severe Coronavirus disease 2019 (COVID‐19)

“…Patients who are on immunosuppressant including steroid have an increased risk of COVID‐19 and its complications. 28 , 29 Preventing the development of COVID‐19, especially severe infection, will be crucial for patients with severe asthma dependent on long‐term steroid. Patients with mild asthma should also be considered to have in‐patient management as they are prone to develop severe COVID‐19 infection, instead of out‐patient management.…”

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

“…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).…”