Increased systemic inflammation linked to symptomatic COVID-19
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Although the seroprevalence of SARS-CoV-2 in patients with immune-mediated inflammatory diseases is comparable to the general population, increased systemic inflammation among these patients is linked to symptomatic COVID-19, according to researchers.
The data, published in The Lancet Rheumatology, also demonstrate that symptomatic COVID-19 occurs less frequently in patients with immune-mediated inflammatory diseases who receive biologic drugs.
“Despite the onset of the COVID-19 pandemic in Europe by March 2020, no large-scale nationwide European seroprevalence studies have been published so far, except in Spain, where the prevalence of antibodies against SARS-CoV-2 in the general population was only 5% by May 2020,” David Saadoun, PhD, of the Groupe Hôpital Pitié-Salpêtrière, Sorbonne University, in Paris, and colleagues wrote. “Many concerns have been raised regarding COVID-19 in patients with immune-mediated inflammatory diseases, which affect an estimated 4.5% of the global population.
“Patients with immune-mediated inflammatory diseases are known to be at higher risk of severe infections, not only due to their baseline immune dysfunction but also as a consequence of immunosuppressant therapy,” they added. “The effect of COVID-19 on the control of disease, including a possible risk of flares, in these patients is another key question. There has been a paucity of data addressing these issues, and whether disease activity, immunomodulatory therapy, or both might have an effect on COVID-19 remains unclear.”
To analyze the serological and clinical prevalence of COVID-19 in patients with immune-mediated inflammatory diseases, as well as the factors linked to infection, Saadoun and colleagues conducted Euro-COVIMID, a multicenter, cross-sectional study of adult patients across six countries. The researchers recruited participants with rheumatoid arthritis, axial spondyloarthritis, systemic lupus erythematosus, Sjögren's syndrome or giant cell arteritis, from six tertiary referral centers in France, Germany, Italy, Portugal, Spain and the United Kingdom, for a questionnaire that collected data on demographics, comorbidities, treatments, disease flares and COVID-19 symptoms.
Participants were systematically tested for SARS-CoV-2 serology. A total of 3,136 participants completed the questionnaire between June 7, 2020, and Dec. 8, 2020. For their analysis, the researchers used data from 3,028 participants symptomatic of COVID-19, serological data, or both. The main outcome was the serological and clinical prevalence of COVID-19. Saadoun and colleagues used multivariable logistic regression to assess factors associated with symptomatic COVID-19. They also examined recent disease flare incidence, changes in treatments for the underlying disease, and the reasons for treatment changes.
According to the researchers, 5.5% of the 3,018 participants who had serology tests demonstrated COVID-19 antibodies (95% CI, 4.7% to 6.4%). Symptomatic COVID-19 occurred in 4% (95% CI, 3.4% to 4.8%) of the 3,028 patients included in the analysis. Among those who were symptomatic, 19.7% were admitted to hospital and 3.3% died.
Higher concentrations of C-reactive protein (OR = 1.18; 95% CI, 1.05-1.33) and higher numbers of recent disease flares (OR = 1.27; 1.02-1.58) were associated with symptomatic COVID-19. Meanwhile, biologic therapy use was associated with a reduced risk for symptomatic COVID-19 (OR = 0.51; 95% CI, 0.32-0.82). At least one disease flare occurred in 21.6% of the 3,028 included patients.
Among 2,514 participants, 20.6% reported treatment changes. Among those who changed treatment, 24.1% said it had been because of the pandemic.
“We found that the overall seroprevalence and severity of SARS-CoV-2 infection in immune-mediated inflammatory diseases (IMIDs) over the study period resembled that of the general population,” Saadoun told Healio Rheumatology. “In addition, systemic inflammatory status of IMIDs, such as higher C-reactive protein levels and a higher number of disease flares, seems to be associated with symptomatic COVID-19. Symptomatic SARS CoV-2 infection occurred less frequently among IMID patients treated with biological therapy.
“Understanding the true prevalence of SARS-CoV-2 in IMID populations and performing reliable risk stratification may be helpful in designing mass vaccination strategies,” he added. “Immunosuppressants do not seem to be deleterious, and the control of inflammatory activity could be a primary goal in the management of IMID patients during the pandemic.”
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