COVID-19 hospitalizations, deaths in patients with SAIRDs declined during omicron wave
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Key takeaways:
- The researchers said vaccination and the less severe omicron variant were the main reasons for improved outcomes.
- Factors linked to death included pulmonary disease and older age.
Hospitalizations and deaths due to COVID-19 in patients with autoimmune rheumatic diseases declined significantly during the most recent 2 years of the pandemic, partly thanks to vaccination among vulnerable populations, according to data.
“Although by the end of 2022 COVID-19 still remained prevalent, the severity of the disease in the general population had considerably decreased compared to earlier phases of the pandemic,” Charalampos Papagoras, MD, PhD, of the University Hospital of Alexandroupolis, in Greece, and colleagues wrote in Clinical Rheumatology. “This is due to infection-acquired, vaccine-induced and hybrid immunity against SARS-CoV-2, as well as the latest dominance of the omicron virus strain, which is thought to cause milder disease.
“Preliminary evidence suggests that COVID-19 runs a milder course during the later phases of the pandemic among patients with SAIRDs, as well,” they added. “However, it is not clear whether this is due to previously acquired anti-SARS-CoV-2 immunity, to infection by the Omicron strain or both.”
To examine whether the availability of COVID-19 vaccines and the emergence of omicron as the dominant strain significantly impacted hospitalizations and mortality in patients with systemic autoimmune rheumatic diseases (SAIRDs), Papagoras and colleagues analyzed data from the Greek Rheumatology Society COVID-19 registry. Patients were included in the analysis if they had a confirmed SAIRD diagnosis and had contracted COVID-19 at some point. Patients were excluded from the analysis if they had been diagnosed with non-inflammatory musculoskeletal diseases like osteoarthritis.
Severe disease was defined hospitalization or death. Patients were evaluated in groups according to vaccination status — vaccinated vs. unvaccinated. Finally, the researchers evaluated the impact of the pandemic through four time periods defined by the dominant strain of disease in Greece. These were the “wild-type” variant, which lasted until the second week of 2021; the alpha variant, which was present until the 26th week of 2021; the delta variant, which was dominant until week 50 of 2021; and the omicron variant, which lasted until June 30, 2022.
During the study period from August 2020 to June 30, 2022, 456 cases of COVID-19 were reported among the cohort. Among unvaccinated individuals in this group, the proportion of patients requiring hospitalization was 24.5% and the proportion of those who died was 4%. Among vaccinated patients, meanwhile, 12.5% were hospitalized and 0.8% died (both P < .001).
According to the researchers, 24.7% of included patients were hospitalized and 2.7% died due to COVID-19 during the wild-type variant period, compared with 31.3% and 4% during the alpha period, 25.9% and 7% during the delta wave, and 8.1% and 0% during the omicron period (P = .001).
Factors associated with hospitalization were infection with variants other than omicron, as well as previous documented exposure to rituximab (Rituxan, Genentech) and not being vaccinated. Factors linked to death included infection during the alpha or delta periods, existing pulmonary disease and older age. Vaccination against COVID-19 was protective, according to the researchers.
“Since the outset of the pandemic, the clinical features of COVID-19 in patients with SAIRDs have changed, with fewer hospitalizations and deaths during the latest phase, similar to the general population,” Papagoras and colleagues wrote. “This overview of the Greek COVID-19 registry shows that the major determinants for this shift was the acquisition of large-scale anti-SARS-CoV-2 immunity, particularly through vaccination, as well as the dominance of the omicron virus strain, which appears to cause a less severe disease.”
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