Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic

Peach, Emily; Rutter, Megan; Lanyon, Peter; Grainge, Matthew J; Hubbard, Richard; Aston, Jeanette; Bythell, Mary; Stevens, Sarah; Pearce, Fiona

doi:10.1101/2020.10.09.20210237

Cited by 14 publications

(18 citation statements)

References 16 publications

(14 reference statements)

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“…To provide more accurate incidence data for these rare diseases, we need contemporary whole population-based studies. This has recently been made possible by the creation of the National Congenital Anomaly and Rare Disease Registration Service by Public Health England and the Registration in Complex Rare Diseases – Exemplars in Rheumatology (RECORDER) project, which aims to identify and build a register of those individuals living with rare diseases, including rare autoimmune rheumatic diseases, amongst the 55 million people living in England(9, 10).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of the Incidence Rate of Takayasu Arteritis

Rutter

Bowley

Lanyon

et al. 2020

Preprint

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ObjectivesTakayasu arteritis (TAK), is a rare autoimmune rheumatic disease causing large vessel vasculitis. Onset is typically between the ages of 20-30. It is associated with substantial morbidity and mortality, notably due to its effects on the cardiovascular system. It has a poorly understood global epidemiology. Our objective was to systematically review the available evidence in order to calculate the incidence rate of TAK.MethodsThree databases (Medline, PubMed and Embase) were searched in November 2019 and the results were screened by two reviewers. A random effects meta-analysis was then conducted in R to calculate the overall incidence rate. Heterogeneity was assessed using I2. The quality of the studies was assessed using an adapted Newcastle-Ottawa scale. Further sub-group analyses were performed by quality, sex, research setting and geographical location. Publication bias was assessed using a Begg’s funnel plot.ResultsThe incidence rate for TAK per million person-years with 95% confidence intervals was 1.11 per million person years (95% CI 0.75 – 1.65). The heterogeneity in the data was extremely high in all analyses, which suggests that there was considerable variation in incidence rates across the different populations studied. TAK was found to be more common in women (incidence rate 2.01 per million person-years, 95% CI 1.39-2.90).ConclusionsTAK is an extremely rare disease. It affects women more commonly than men. There is considerable variation in the incidence rate between populations. We suggest that future research should focus on discrete populations in order to better identify genetic and environmental risk factors.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of the Incidence Rate of Takayasu Arteritis

Rutter

Bowley

Lanyon

et al. 2020

Preprint

Self Cite

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“…The Registration of Complex Rare Diseases Exemplars in Rheumatology (RECORDER) project looked at the risk of death from COVID-19 among those with rare autoimmune diseases and found a higher mortality rate compared with the general population (1.1% vs 0.6%) with women having similar risk of death compared to men in this cohort. 9 Diabetes mellitus, hypertension and obesity are significant risk factors for hospitalisation and mortality in COVID-19. 10 Lupus patients have higher rates of hypertension, diabetes mellitus, obesity and sedentary lifestyle, 11 putting them at higher risk from COVID-19 due to excess co-morbidity.…”

Section: Sle and Covid-19mentioning

confidence: 99%

Lupus, vaccinations and COVID-19: What we know now

Mason

Anver

Lwin

et al. 2021

Lupus

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services, with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Patients with systemic lupus erythematosus (SLE) are at increased risk of viral infections, and recent data suggests they may be at an increased risk of poor outcomes with COVID-19. This may be particularly true for those on rituximab or high dose steroids. A huge international effort from the scientific community has so far resulted in the temporary authorisation of three vaccines which offer protection against SARS-CoV-2, with over 30 other vaccines being evaluated in ongoing trials. Although there has historically been concern that vaccines may trigger disease flares of SLE, there is little convincing evidence to show this. In general lupus patients appear to gain good protection from vaccination, although there may be reduced efficacy in those with high disease activity or those on immunosuppressive therapies, such as rituximab or high dose steroids. Recent concerns have been raised regarding rare clotting events with the AstraZeneca/Oxford vaccine and it is currently unknown whether this risk is higher for those patients with secondary antiphospholipid syndrome. With the possibility of annual COVID vaccination programmes in the future, prospective data collection and registries looking at the effect of vaccination on SLE disease control, the incidence of COVID-19 in SLE patients and severity of COVID-19 disease course would all be useful. As mass vaccination programmes begin to roll out across the world, we assess the evidence of the use of vaccines in SLE patients and in particular vaccines targeting SARS-CoV-2.

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“…Similarly, Italy, one of the European countries hardest hit by the outbreak, has a significantly higher prevalence of COVID-19 among the RADs population than in the general population (1). In England, a study involving 168,691 subjects adopted an index of age-standardized mortality rate (ASMR), and identified a higher risk of COVID-19 infection in RADs population (11). According to a nationwide cohort study from Denmark, RADs patients had an increased COVID-19 associated hospitalization rate, compare to 4.5 million general population (12).…”

Section: Epidemiological Featuresmentioning

confidence: 99%

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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Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic

Cited by 14 publications

References 16 publications

A Systematic Review and Meta-Analysis of the Incidence Rate of Takayasu Arteritis

A Systematic Review and Meta-Analysis of the Incidence Rate of Takayasu Arteritis

Lupus, vaccinations and COVID-19: What we know now

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

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