Risk for severe COVID-19 in patients with SARDs has fallen 71% since early pandemic
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Patients with systemic autoimmune rheumatic diseases who developed COVID-19 during the first omicron wave were 71% less likely to experience severe outcomes than those who caught it in the first 4 months of the pandemic, according to data.
However, despite these improvements in the risks for hospitalization and death, the absolute number of reported patients with systemic autoimmune rheumatic diseases (SARDs) who developed severe COVID-19 during the initial omicron wave was similar to that of previous waves, the researchers added.
“Our team has been systematically identifying COVID-19 cases among patients with systemic autoimmune rheumatic disease at Mass General Brigham since the beginning of the pandemic,” Jeffrey A. Sparks, MD, MMSc, of Harvard Medical School and Brigham and Women's Hospital, told Healio. “We were interested to investigate how the risk for developing severe outcomes for COVID-19 for patients with systemic autoimmune rheumatic diseases have changed throughout the pandemic.
“We were particularly interested to investigate the initial omicron wave that was characterized by high infectivity and many COVID-19 cases,” he added.
To investigate how the incidence and severity of COVID-19 in patients with SARDs has changed since the earliest days of the pandemic, Sparks and colleagues conducted a retrospective cohort study. They included patients with SARDs who had tested positive for COVID-19 between March 1, 2020, and Jan. 31, 2022, who received care at the Mass General Brigham HealthCare system, using PCR tests to confirm diagnoses. Patients who tested positive at home or outside of the health care system were also included.
Meanwhile, those who were receiving treatment for osteoarthritis, fibromyalgia, mechanical back pain, Raynaud’s phenomenon, gout or pseudogout alone were excluded.
For this analysis, the date of COVID-19 onset was defined as the first date of PCR positivity, the date of the first COVID-19 flag, or the confirmed date of a positive test according to a medical record review or referral. Time periods were divided into several categories, with the early COVID-19 period defined as March 1, 2020, to June 30, 2020. The early treatment period was defined as July 1, 2020, to January 2021, while the early vaccination period spanned from Feb. 1, 2021, to June 30, 2021.
The period characterized as “additional vaccination and delta wave” was defined as July 1, 2021, to Dec. 16, 2021. Finally, the initial omicron wave period was defined as Dec. 17, 2021, to Jan. 31, 2022. The authors defined severe COVID-19 as a composite of hospitalization or death within 30 days from the infection date.
In total, the analysis included 1,449 patients with SARDs who had COVID-19, of whom 399 developed severe cases.
According to the researchers, who published their fundings in the Annals of the Rheumatic Diseases, the proportion of severe cases decreased with calendar time. Among those who developed COVID-19 during the early period, 46% experienced severe outcomes, compared with 15% during the initial omicron wave (adjusted OR = 0.29; 95% CI, 0.19-0.43). There were more severe cases among unvaccinated patients compared with vaccinated patients — 78% vs. 60% — the researchers added.
“We found that the odds of patients with SARDs experiencing severe COVID-19 were 71% lower in the initial omicron wave compared to early in the pandemic,” Sparks said. “Since there were many infections in the initial omicron wave, the absolute number of patients with systemic autoimmune rheumatic diseases experiencing severe outcomes was still similar to previous waves. This emphasizes that some of these patients may still be at risk for poor outcomes.
“Since so much has changed throughout the pandemic, there are many possible factors that could explain our findings,” he added. “These include test availability, hospital capacity, vaccines, treatment advances and different virulence of SARS-CoV-2 variants.”
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