Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases

Bachiller‐Corral, Javier; Boteanu, Alina; García-Villanueva, María Jesús; Puente, Carlos de la; Revenga, Marcelino; Diaz-Miguel, M. Consuelo; Rodríguez-García, Ana; Hita, J.L. Morell; Valero, Marta; Larena, Carmen; Cañamero, María Ángeles Blázquez; Astete, Carlos Antonio Guillén; Garrote, Sandra; Sobrino, Cristina; Medina-Quiñones, Carmen; Vázquez-Díaz, Mónica

doi:10.3899/jrheum.200755

Cited by 55 publications

(61 citation statements)

References 22 publications

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“…Regarding previous use of immunomodulatory therapies by patients with AARD, our study shows that prior treatment with mycophenolate mofetil and rituximab was more frequent in the “serious illness” or the hospitalization group, in line with most of the previous published data [ 4 , 14 , 17 , 25 , [39] , [40] , [41] ]. It is though important to emphasize that any possible association between rituximab and COVID-19 could have also been influenced by the typical coadministration of corticosteroids [ 14 , 37 , [42] , [43] , [44] ]. Notably, the majority of our patients treated with anti-cytokine monotherapy developed a mild disease course, while among the two patients in critical condition, the one who finally died presented almost all risk factors associated with hospitalization and death.…”

Section: Discussionmentioning

confidence: 99%

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

Bakasis

Mavragani

Boki

et al. 2021

Journal of Autoimmunity

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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.

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Section: Discussionmentioning

confidence: 99%

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

Bakasis

Mavragani

Boki

et al. 2021

Journal of Autoimmunity

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“…Hassali et al reported that 67% of the patients treated with rituximab in the National Registry for patients with rheumatic diseases infected with SARS-CoV-2 in Germany required hospitalization [ 24 ]. Two recent European studies reported that rituximab therapy is associated with more severe COVID-19 [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 pneumonia in a patient with granulomatosis with polyangiitis on rituximab: case-based review

et al. 2021

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A 77-year-old man with past medical history of granulomatosis with polyangiitis (GPA) on rituximab and prednisone, presented to the hospital with worsening cough and shortness of breath. He had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by nasal swab polymerase chain reaction (PCR) while asymptomatic, 6 weeks earlier. He started with cough and shortness of breath 2 weeks after his initial positive test. After developing symptoms, he tested negative twice by nasal swab PCR, but the PCR of his bronchioloalveolar lavage was positive for SARS-CoV-2. He did not develop antibodies against coronavirus. Prednisone 15 mg daily was continued, and he received remdesivir, and convalescent plasma with quick recovery. We reviewed the literature to search for similar cases. Our case suggests that SARS-CoV-2 infection in patients on rituximab may have an atypical presentation and the diagnosis may be delayed due to negative PCR testing in the nasal swab. Patients may benefit from treatment with convalescent plasma.

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“…Univariable logistic regression analyses were performed to assess differences between asymptomatic or symptomatic cases and also hospital admissions related to COVID-19 risk and covariates. Multivariable logistic regression models (adjusted for age, sex) were run in a stepwise manner to examine the possible effect of sociodemographic, clinical, and therapeutic factors on symptomatic COVID-19 and hospital admissions related to COVID- 19 The model also included all other variables with a p<0.1 from the univariable regression analysis. The results were expressed as the odds ratio (OR) with its respective 95% confidence interval.…”

Section: Methodsmentioning

confidence: 99%

Clinical characteristics and COVID-19 outcomes in a regional cohort of pediatric patients with rheumatic diseases

Clemente

Udaondo

Arocena

et al. 2021

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Background: This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in pediatric patients with rheumatic and musculoskeletal diseases (RMD) and identify the risk factors associated with symptomatic or severe disease defined as hospital admission, intensive care admission or death. Methods: An observational longitudinal study was conducted during the first year of pandemic SARS-CoV-2 (1st March 2020 to 1st March 2021). All pediatric patients attended at the rheumatology outpatient clinic of six tertiary hospital in Madrid, Spain, with a medical diagnosis of RMD and COVID-19 were included. Main outcomes were symptomatic disease and hospital admission. The covariates were sociodemographic, clinical, and treatments. We ran a multivariable logistic regression model to assess risk factors for outcomes. Results: The study population included 77 pediatric patients. Mean age was 11.88 (4.04) years Of these, 30 patients were asymptomatic, 41 had a mild or moderate disease and other 6 patients (7.79%) required hospital admission related to COVID-19. The median length of stay was 5 (2-20) days and there was no death. Previous comorbidities increased the risk for symptomatic disease and hospital admission. Compared with outpatients, the factor independently associated with hospital admission was the use of glucocorticoids (OR 1.08; p=0.00). No statistically significant findings for symptomatic COVID-19 were found in the final model. Conclusion: Our data found no differences in COVID-19 outcomes between children-onset rheumatic diseases. Our results suggest that associated comorbidities and being in treatment with glucocorticoids increase the risk of hospital admission.

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Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases

Cited by 55 publications

References 22 publications

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

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

COVID-19 pneumonia in a patient with granulomatosis with polyangiitis on rituximab: case-based review

Clinical characteristics and COVID-19 outcomes in a regional cohort of pediatric patients with rheumatic diseases

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