My name is Pedro Machado. I'm an associate professor and consultant rheumatologist at the University College London in London, UK. And I'm the chair of the standing committee for Epidemiology and Health Services Research off EULAR. EULAR is the European League Against Rheumatism.
So the COVID-19 pandemic caused by the SARS-CoV-2 virus is of particular concern for people with rheumatic and musculoskeletal diseases or those that are immunosuppressed in general, whether having a rheumatic disease or receiving immunosuppressive therapy is associated with a more severe infection and a poor outcome was unknown.
Now to address this knowledge gap, EULAR in collaboration with a global network of rheumatologists, scientists, and patients at the Global Rheumatology Alliance, we developed the physician reported case registry of people with rheumatic diseases diagnosed with COVID-19. This has been a very successful initiative.
And by the end of this week, we expect to have over 2,000 case entries originating from 13 different European countries. And then adding to these, there will be more than 1,000 cases available in the global database, making a total of 3,000 cases worldwide in what has been an amazing effort from the rheumatology community. And I am really grateful to all the colleagues that have contributed to this effort.
And just a few days ago the first report of this international collaboration was published. This is data from the first 600 patients submitted to the combined EULAR and global registry and data that we analyzed and published in the Annals of Rheumatic Diseases.
Now in this study, we aimed to identify factors associated with hospitalization for COVID-19 patients with inflammatory rheumatic diseases. And we found that as in the general population, people with rheumatic diseases are older or have comorbidities such as cardiovascular disease, lung disease, diabetes, or chronic renal disease were more likely to be hospitalized due to COVID-19.
Now these findings are not surprising and very similar to what has been described in the general population. With regards to the specific drugs that we use in rheumatology, taking non-steroidal anti inflammatory drugs and disease modifying anti rheumatic drugs, some of them some of which are immunosuppressants, so these are drugs like hydroxychloroquine, methotrexate, biologic drugs, or JAK inhibitors. None of these drugs were associated with an increased likelihood of hospitalization, which was extremely reassuring.
However, taking an oral steroid dose of 10 milligrams or more prednisolone equivalent. And prednisolone is one of the most commonly used steroids. And this would be considered moderate to high dose. This was associated with an increased likelihood of hospitalization. And again, it's a finding that has been described in other populations.
And finally, a very interesting finding was that we found that patients taking TNF inhibitors, so this is one of the biologic drugs that we use in rheumatology, so these patients were actually less likely to be hospitalized due to COVID-19.
Now I think it is important to highlight that this was an observational study, and we describe are associations, and we cannot say they are causal relationships. This is a voluntary registry. And therefore, we cannot capture all patients with rheumatic diseases diagnosed with COVID-19.
And what I mean by this is that there is the possibility of selection bias and confounding by indication. And although we conduct multiple adjustments and sensitivity analysis, that this cannot definitely be excluded. However, it is reassuring that the results of the various models were always very consistent. And this is all presented in the paper that was recently published.
So in summary, this study described the largest collection of COVID-19 cases amongst patients with rheumatic diseases, with 600 cases from 40 countries. It provides for the first time information about the outcome of COVID-19 in patients with rheumatic diseases. And it informs about the risk factors for hospitalization.
This study demonstrated that most individuals with rheumatic diseases or on immunosuppressive therapies do recover from COVID-19, which should provide some reassurance to patients and health professionals. And finally, these results will inform the management of patients with rheumatic diseases in the context of COVID-19 and are for relevant to all rheumatologists and other health care professionals treating patients with rheumatic diseases worldwide.
In terms of the conversations that clinicians and other health care professionals should be having with their patients and the implications of the results of this study to patient management. At the beginning of the pandemic, there was really a big concern that because we are giving these powerful drugs that block cytokines and some of them are immunosuppressive drugs, there was a big concern that this could result in a worse outcome if patients acquired SARS-CoV-2 infection and COVID-19, which is the disease caused by the virus.
And these results actually provide reassurance that probably that is not the case. So for the entire rheumatology community, it is actually quite reassuring to see this. And I think it emphasizes that previous recommendations from international national societies that patients should not be stopping their medication because of they're afraid of contracting the virus.
It could actually be much worse if they stopped the medication because then the disease gets out of control. And then the underlying immune dysfunction, that is a common characteristic in many rheumatic diseases and the increase in disease activity, that could have a much worse the effect, than the effect of taking these drugs, which apparently they are not making the outcome of COVID-19 worse.
And in fact, there is the possibility that one of the drugs might have some kind of protective role. But again, this was an association and that could only be tested in proper and adequately powered randomized controlled trials.
So in terms of the next steps of COVID-19 research, but specifically with regards to using this database, as we acquire more data, we'll be able to look at less common outcomes. So one of the things that we're planning to look at is the outcome of fatality death and ventilation, for example.
And also as we acquire more data, we'll be able to look at more granular things, like things like specific medications, specific comorbidities, or specific disease, especially the ones that are less common. And I think in terms of COVID-19 research in general, obviously the key thing is to start obtaining results from randomized controlled trials, which are currently happening. And these are trials of antiviral therapies, anti-inflammatory therapies, namely the context of severe COVID-19 and in the context of cytokine storm.
And obviously the other key thing is the vaccine. There are now probably more than 100 potential vaccines being studied. And it will be really important to understand that if those vaccines can indeed be protective and safe to administer to the population, because that will be critical in terms of the management of this pandemic.