Rheumatic diseases do not increase risk for severe COVID-19 outcomes
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Patients with rheumatic diseases, including rheumatoid arthritis and systemic lupus erythematosus, have a similar risk for severe COVID-19 outcomes as the general population, according to a speaker at ACR Convergence 2020.
“The risk of poor outcomes from COVID-19 among rheumatic disease patients compared to the general population remains poorly understood, and patients and providers remain concerned about the risks,” Naomi Serling-Boyd, MD, of Massachusetts General Hospital, said in a recorded late-breaking poster session. “We previously observed a higher risk of mechanical ventilation in patients with rheumatic diseases compared to the general population in a small cohort study early in the pandemic.”
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To analyze the risk for severe COVID-19 outcomes among patients with rheumatic diseases, Serling-Boyd and colleagues conducted a comparative cohort study of patients with PCR-confirmed COVID-19 between Jan. 13 and July 16 across a multicenter health care system. Participants included 143 patients with a rheumatic disease and 688 matched comparators from a potential pool of 16,211 patients with confirmed COVID-19 but without rheumatic disease. The most common rheumatic diseases were RA, with 31% of included participants, and SLE, with 19%.
Among the participants with rheumatic diseases, 36% were receiving glucocorticoids, 21% were being treated with hydroxychloroquine, 29% were on at least one biologic disease-modifying antirheumatic drug and 31% were receiving at least one conventional synthetic DMARD.
The researchers compared each patient with rheumatic disease with up to five comparators matched by age, sex and date of confirmed COVID-19 PCR. The primary analysis included multivariable Cox proportional hazard regression to estimate hazard ratios and 95% confidence intervals for COVID-19 outcomes, comparing patients with and without rheumatic disease and adjusting for potential confounders. Outcomes were assessed through end of follow-up in the system or Aug. 18.
Lastly, to further evaluate temporal trends in mechanical ventilation among patients with rheumatic disease, Serling-Boyd and colleagues compared risk among early and recent cohorts — specifically those with PCR testing before and after the midpoint among rheumatic disease patients — using similar methods.
According to the researchers, participants with rheumatic disease demonstrated a higher unadjusted risk for mechanical ventilation compared with comparators (unadjusted HR = 1.75; 95% CI, 1.12-2.74). However, after adjusting for race, smoking and CCI, there were no significantly higher risk for hospitalization (HR = 0.87; 95% CI, 0.68-1.11), intensive care unit admission (HR = 1.27; 95% CI, 0.86-1.86), mechanical ventilation (HR = 1.51; 95% CI, 0.93-2.44), or death (HR = 1.02; 95% CI, 0.53-1.95) among patients with rheumatic disease compared with those without.
In addition, the researchers observed a trend toward improvement in the risk for mechanical ventilation over time among those with rheumatic disease, with 10% in the recent cohort compared with 19% in the early cohort (adjusted HR = 0.44; 95% CI, 0.17-1.12).
“Patients with rheumatic disease had a similar risk of severe COVID-19 outcomes compared with matched comparators,” Serling-Boyd said. “There was also a temporal trend toward improvement in the risk of mechanical ventilation for rheumatic disease patients. These findings provide reassurance for rheumatic disease patients, although close monitoring of patients with other comorbidities is warranted.”
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Serling-Boyd N. Abstract L01. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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