Risks of mortality and severe coronavirus disease 19 (COVID-19) outcomes in patients with or without systemic lupus erythematosus

Abstract

ObjectivesWe compared the outcomes of patients with or without systemic lupus erythematosus (SLE) who were diagnosed with coronavirus disease 19 (COVID-19) and evaluated factors within patients with SLE associated with severe outcomes.MethodsThis retrospective cohort study used the deidentified Optum COVID-19 electronic health record dataset to identify patients with COVID-19 from 1/1/2020 to 31/12/2020. Cases with SLE were matched with general controls at a ratio of 1:10 by age, sex, race and ethnicity and COVID-19 diagnosis date. Outcomes included 30-day mortality, mechanical ventilation, hospitalisation and intensive care unit admission. We evaluated the relationship between COVID-19-related outcomes and SLE using multivariable logistic regression. In addition, within SLE cases, we examined factors associated with COVID-19 related outcomes, including disease activity and SLE therapy.ResultsWe included 687 patients matched with 6870 controls. Unadjusted rates of outcomes for patients with SLE were significantly worse than for matched controls including mortality (3.6% vs 1.8%), mechanical ventilation (6% vs 2.5%) and hospitalisation (31% vs 17.7%) (all p<0.001). After multivariable adjustment, patients with SLE had increased risks of mechanical ventilation (OR 1.81, 95% CI 1.16 to 2.82) and hospitalisation (OR 1.32, 95% CI 1.05 to 1.65). Among patients with SLE, severe disease activity was associated with increased risks of mechanical ventilation (OR 5.83, 95% CI 2.60 to 13.07) and hospitalisation (OR 3.97, 95% CI 2.37 to 6.65). Use of glucocorticoids, mycophenolate and tacrolimus before COVID-19 was associated with worse outcomes.ConclusionPatients with SLE had increased risk of severe COVID-19-related outcomes compared with matched controls. Patients with severe SLE disease activity or prior use of corticosteroids experienced worse outcomes.

COVID-19 prognosis in systemic lupus erythematosus compared with rheumatoid arthritis and spondyloarthritis: results from the CONTROL-19 Study by the Italian Society for Rheumatology

“…Major risk factors linked to a more severe infection were disease activity and GC use, together with use of mycophenolate and tacrolimus. 28 …”

The outcome of COVID‐19 in patients with autoimmune rheumatic diseases: Comparable to the general population or worse?

“…However, the results of different studies are conflicting regarding the effects of immunosuppressive drugs on COVID‐19 severity. In the study by Bruera et al 1 including 687 SLE patients and 6870 controls, negative effects of COVID‐19 were associated with glucocorticoids, methotrexate, leflunomide, cyclosporine, and tacrolimus; but not with azathioprine, cyclophosphamide, or rituximab. Furthermore, belimumab had a protective effect against severe COVID‐19 1 .…”

“…In the study by Bruera et al 1 including 687 SLE patients and 6870 controls, negative effects of COVID‐19 were associated with glucocorticoids, methotrexate, leflunomide, cyclosporine, and tacrolimus; but not with azathioprine, cyclophosphamide, or rituximab. Furthermore, belimumab had a protective effect against severe COVID‐19 1 . In contrast, Singh et al 30 reported that rituximab conferred 3–5 fold higher odds of intensive care unit admission and mechanic ventilation in RA, in a national cohort study including 69 549 RA patients.…”

“…Thus, the dysregulated immune system with a tendency to overreact could make AIRD patients more prone to negative COVID‐19 outcomes. The type of AIRD, disease activity, and organ involvements are also important while analyzing the impact of AIRDs on the COVID‐19 course 1,2 . In addition, classical comorbidities such as hypertension, obesity, and diabetes mellitus are generally more frequent among AIRD patients than the general population, and these comorbidities are associated with worse COVID‐19 outcomes 3,4 .…”

“…However, the number of studies focusing on specific AIRDs has been increasing. Bruera et al 1 have recently reported that COVID‐19 outcomes were worse in patients with systemic lupus erythematosus (SLE) compared to controls, even after adjustments for comorbidities. This finding suggests that negative outcomes are at least partially associated with SLE.…”