COVID-19 global registry data key in rheumatic disease management
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Data from U.S. and European COVID-19 registries of patients with rheumatic diseases have yielded actionable information to help rheumatologists manage patients with the virus, according to data presented at EULAR 2022 Congress.
“Our patients, and doctors, and other health care professionals, they were all very worried because, potentially, they could be at risk for severe disease and severe outcomes for SARS-CoV-2 infection,” Pedro Machado, MD, associate professor and consultant in rheumatology and neuromuscular diseases at University College London, University College Hospital, National Hospital for Neurology and Neurosurgery and Northwick Park Hospital, said in a press conference.
There were three key reasons for this concern, according to Machado. One is the negative impact of rheumatologic and autoimmune diseases on the ability of the immune system to combat the infection. Another is the negative impact of immunomodulatory drugs on the immune system. The third is the fact that many immune-mediated inflammatory diseases affect multiple organ systems, ranging from the skin and joints to the heart and lungs. “Because of all these reasons, there was a lot of concern about our patients,” Machado said.
Machado discussed data from the PsoProtect and Global Rheumatology Alliance physician-reported registries.
“There was a need to rapidly collect data for patients with rheumatic diseases who developed COVID,” he said.
The pooled analysis included findings for more than 5,000 patients. Results showed a hospitalization rate of 14.6% and a mortality rate of 1.8%.
Increasing age was a key driver of more serious outcomes from the virus. In addition, men were more likely than women to experience severe infection.
“We were also able to show that many of the risk factors that are associated with a worse outcome of COVID-19 in the general population are also risk factors in patients with rheumatic diseases,” Machado said.
Underlying comorbidities such as hypertension, lung disease, chronic kidney disease and diabetes all were drivers of more severe COVID-19 outcomes.
In addition, patients with higher disease activity for their rheumatic or autoimmune condition were more likely to experience complications from COVID-19.
However, the news was not all bad. Several disease-modifying anti-rheumatic drugs — including interleukin (IL)-17 inhibitors, IL-23/IL-12+23 inhibitors, Janus kinase inhibitors and apremilast (Otezla, Amgen) — have been deemed safe in COVID-19, in that they did not demonstrate associations with poorer outcomes.
“We were able to demonstrate that many of the drugs we use in rheumatology, including many of the biologic drugs, are actually quite safe in the context of SARS-CoV-2 infection,” Machado said.
That said, glucocorticoids and B-cell depleting therapies such as rituximab (Rituxan, Genentech) have demonstrated some complications in the COVID-19 setting, according to Machado.
“These data have really informed the management of patients with rheumatic diseases,” he said.
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Machado P. Characteristics associated with poor COVID-19 outcomes in people with psoriasis and spondyloarthritis: data from the COVID-19 PsoProtect and Global Rheumatology Alliance physician-reported registries. Presented at: EULAR 2022 Congress; June 1-4, 2022 (virtual meeting).
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