Worse COVID-19 outcomes in lupus driven by demographics, untreated disease
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Worse COVID-19 outcomes in patients with systemic lupus erythematosus are driven by comorbidities, demographics and untreated or active disease, according to data published in the Annals of the Rheumatic Diseases.
The researchers added that patients using low-dose glucocorticoids also demonstrated more severe COVID-19 outcomes.
“In individuals with SLE, more severe COVID-19 outcomes are mainly driven by demographic factors, comorbidities, active SLE, the use of prednisone and by untreated disease,” Manuel Francisco Ugarte-Gil, MD, MSc, of the Universidad Cientifica del Sur, and the Hospital Nacional Guillermo Almenara Irigoyen, in Lima, Peru, told Healio. “In our age- and sex-adjusted analysis, individuals using rituximab, cyclophosphamide and mycophenolate had more severe outcomes, although some of these risks were attenuated after adjusting for comorbidities. Our study also provides new and reassuring data regarding belimumab.”
To analyze the factors that are associated with more severe COVID-19 outcomes in patients with SLE, Ugarte-Gil and colleagues studied data from the COVID-19 Global Rheumatology Alliance and the EULAR COVID-19 registry. The researchers included 1,606 patients with SLE who had been enrolled in either registry from March 12, 2020, to June 1, 2021. Patients’ ordinal severity outcome was categorized as either “not hospitalized,” “hospitalized with no oxygen,” “hospitalized with any ventilation or oxygenation,” or “death.”
In their analysis, the Ugarte-Gil and colleagues used a multivariable ordinal logistic regression model to determine the relationship between COVID-19 severity and demographic information, comorbidities, medication and disease activity.
According to the researchers’ multivariate model, older age (OR = 1.03; 95% CI, 1.02-1.04); male sex (OR = 1.5; 95% CI, 1.01-2.23); daily prednisone doses of 1 mg to 5mg (OR = 1.86; 95% CI, 1.2-2.66), 6 mg to 9mg (OR = 2.47; 95% CI, 1.24-4.86) or 10 mg or more (OR = 1.95; 95% CI, 1.27-2.99); no current treatment (OR = 1.8; 95% CI, 1.17-2.75); comorbidities including kidney disease (OR = 3.51; 95% CI, 2.42-5.09 and cardiovascular disease/hypertension (OR = 1.69; 95% CI, 1.25-2.29); and moderate (OR = 1.61; 95% CI, 1.02-2.54) or high (OR = 3.94; 95% CI, 2.11-7.34) SLE disease activity, compared with remission, were associated with more severe outcomes.
In age- and sex-adjusted models, mycophenolate mofetil, rituximab (Rituxan, Genentech) and cyclophosphamide use were associated with worse COVID-19 outcomes, compared with hydroxychloroquine. Patients’ outcomes were more favorable with methotrexate and belimumab (Benlysta, GlaxoSmithKline) use.
“These data allow us to determine which individuals should be prioritized for close monitoring,” Ugarte-Gil said. “These data also reinforce the importance of vaccination and the use of preventive therapies to improve outcomes in these patients.”
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