Patients with inflammatory rheumatic disease at higher risk for severe COVID-19
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Key takeaways:
- Patients with IRDs are no more likely to contract COVID-19 than those without.
- However, patients with IRDs are more likely to have severe outcomes from COVID-19.
Patients with inflammatory rheumatic diseases are as likely as the general population to contract COVID-19, but are at a higher risk for severe outcomes, including hospitalization and death, according to data.
“Patients with [inflammatory rheumatic diseases (IRD)] may have increased risk of infection due to their underlying rheumatic disease, comorbidities, older age and immunosuppressive treatments,” Annemarie Lyng Lyng Svensson, MD, PhD, of Rigshospitalet, in Denmark, and colleagues wrote in Annals of the Rheumatic Diseases. “The SARS-CoV-2 pandemic initially raised concerns about the risk of severe infection in patients with IRD.
“Preliminary data were reassuring about the risk of severe COVID-19 pneumonia in patients with IRD treated with targeted biological or synthetic disease-modifying anti-inflammatory agents,” they added. “Studies on patients with IRD regarding severity and mortality from COVID-19 has shown diverging results.”
To investigate whether patients with inflammatory rheumatic diseases demonstrate a higher risk for COVID-19, and if their outcomes are worse, vs. the general population, Svensson and colleagues conducted a nationwide, population-based registry study of all registered residents of Denmark aged 18 to 90 years on March 1, 2020, who had an inflammatory rheumatic disease. For every patient in the inflammatory rheumatic disease cohort, 10 comparator individuals from the general population were included.
Measured outcomes included time from the beginning of the study through several events. These included dates of the first positive SARS-CoV-2 test, the second positive test, first hospitalization with a COVID-19 diagnosis, first hospitalization credited to severe COVID-19, hospitalization requiring ventilation intervention, hospitalization leading to death, and all-cause death.
The analysis included 66,840 patients with inflammatory rheumatic disease and 668,400 individuals in the comparator group. According to the researchers, patients with inflammatory rheumatic diseases demonstrated a shorter time to the first (IRR = 1.06; 95% CI, 1.05-1.07) and second (IRR = 1.21; 95% CI, 1.15-1.27) positive COVID-19 tests.
In addition, they were more likely to enter the hospital with COVID-19 (IRR = 2.11; 95% CI, 1.99-2.23) and severe COVID-19 (IRR = 2.18; 95% CI, 1.94-2.45) vs. the comparators. They were also more likely to require ventilation (IRR = 2.33; 95% CI, 1.89-2.87) and had a higher chance of dying (IRR = 1.98; 95% CI, 1.69-2.33), compared with those without inflammatory rheumatic disease.
Patients with IRD additionally demonstrated more comorbidities vs. the general population. Meanwhile, a third COVID-19 vaccine dose was associated with a lower risk for COVID-19 hospitalization and death, according to the researchers.
“Danish patients with IRD had nearly the same risk of testing positive for SARS-CoV-2 as the general population but had a substantial increased risk of hospitalization with COVID-19, severe COVID-19, requiring assisted ventilation and COVID-19 leading to death, especially in patients with comorbidities,” Svensson and colleagues wrote. “The IRD population is heterogeneous with some substantial differences between the groups, however subgroups of patients with IRD are at a greater risk of more severe COVID-19 infections.”
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