Severe infection, rituximab use predict long COVID in patients with autoimmune disease
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WASHINGTON — Severe acute COVID-19 infection, as well as glucocorticoid and rituximab use, increase the risk for long COVID in patients with autoimmune rheumatic diseases, according to data presented at ACR Convergence 2024.
“We know from the work of several people from the height of the pandemic that autoimmune rheumatic disease patients were at higher risk of severe outcomes from this disease, including people with comorbidities or people who were on certain drugs, like rituximab,” Namrata Singh, MD, MSCI, FACP, of the University of Washington, told attendees.
To examine the prevalence and factors associated with long COVID among patients with autoimmune rheumatic diseases, Singh and colleagues analyzed data for more than 16 million patients from the National COVID Cohort Collaborative. Individuals within the cohort had their first COVID-19 infection between October 2021 and March 2023, with follow-up data available through March 2024.
The propensity-score matched cohort included 67,721 patients with autoimmune rheumatic diseases and the same number of patients without autoimmune rheumatic diseases.
“I wanted to convey the message that we were able to achieve a fine balance between the two groups,” Singh said.
According to the researchers, patients in the autoimmune rheumatic disease cohort demonstrated a long COVID rate of 2.8%, vs. 1.7% in the non-autoimmune disease group. Multivariable adjusted analysis results showed that the risk for long COVID was elevated in the autoimmune rheumatic disease cohort (aHR = 1.62; 95% CI, 1.5-1.76).
“There was a 62% higher risk of developing long COVID among people with our diseases,” Singh said.
According to Singh, patients with these diseases are often “much more attuned with their health” and may be more likely to seek health care. This could lead to elevated rates of long COVID diagnosis, she added. However, when the researchers adjusted for health care use, the risk for long COVID persisted (aHR = 1.57).
Singh and colleagues additionally conducted a secondary analysis to determine long COVID rates among specific diseases, using rheumatoid arthritis as the referent.
“There were no differences among rheumatic diseases,” Singh said. “There was no increased risk of long COVID compared with RA.”
Meanwhile, factors that increased the risk for long COVID included moderate or severe COVID-19 infection, as well as the use of rituximab (Rituxan, Genentech) and glucocorticoids.
“Development of long COVID in our patients was strongly associated with having severe infection,” Singh said. “At the end of the day, when taking this back to the clinic, we have highlighted some risk factors that can help you risk stratify of which patients will develop long COVID.”
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Singh N. Abstract #2615. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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