Outpatient COVID therapy linked to 88% lower odds of severe outcomes in AIRD patients
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Patients with autoimmune rheumatic disease who receive outpatient therapy are 88% less likely to develop severe COVID-19 outcomes vs. with those who do not undergo outpatient therapy, according to data published in The Lancet Rheumatology.
“We were interested to investigate the risk for COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases in a contemporary setting that included oral outpatient treatment options such as nirmatrelvir/ritonavir (Paxlovid, Pfizer),” Jeffrey A. Sparks, MD, MMSc, of Harvard Medical School and Brigham and Women’s Hospital, told Healio. “We investigated whether outpatient SARS-CoV-2 treatment was associated with lower risk of severe COVID-19, especially considering the availability of novel oral outpatient treatment options.”
To compare outcomes between individuals who received outpatient care for COVID-19, compared with those who did not, Sparks and colleagues conducted a retrospective study of patients with a pre-existing systematic autoimmune rheumatic disease who were seen at the Massachusetts General Brigham Integrated Health Care System. The researchers examined the hospital’s patient database for adults who had a positive PCR or antigen test for COVID-19 between Jan. 23 and May 30, 2022. Patients who tested positive for COVID-19 outside of the system, including home tests, were also included.
The main variable of investigation was the presence, or lack of, outpatient therapy. Secondary exposures of interest included specific oral outpatient therapies that patients received. The main outcome was the presence of severe COVID-19, as defined by hospitalization or death within 30 days of infection. Additionally, the researchers examined which patients experienced rebound infections following their outpatient therapy.
The study included data from 704 patients, among whom 347 had rheumatoid arthritis. According to the researchers, outpatient COVID-19 treatments increased in prevalence throughout the study period (P < . 0001). In all, 426 patients received outpatient therapy. Among these patients who received outpatient treatment, there were nine hospitalizations or deaths, compared with 49 hospitalizations or deaths among those who did not receive outpatient therapy (OR = 0.12; 95% CI, 0.05-0.25). Additionally, 7.9% of patients who underwent outpatient therapy experienced COVID-19 rebound.
“Outpatient treatment was strongly associated with lower risk of severe COVID-19 among patients with systemic autoimmune rheumatic diseases,” Sparks said. “Even among a highly vaccinated population, treatment with medications such as nirmatrelvir/ritonavir or monoclonal antibodies was associated with 88% lower odds of severe COVID-19 than no outpatient treatment. These findings highlight the importance of outpatient SARS-CoV-2 treatment for patients with systemic autoimmune rheumatic diseases with COVID-19.”
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