Corticosteroid use may be a risk factor for COVID-19 hospitalization in rheumatic disease patients
medwireNews: Study results from the COVID-19 Global Rheumatology Alliance suggest that corticosteroid use at moderate-to-high doses may be associated with an increased risk for hospitalization among people with rheumatic diseases and SARS-CoV-2 infection.
As outlined by Jinoos Yazdany (University of California, San Francisco, USA) at the virtual 2020 ACR State-of-the-Art Clinical Symposium, the study included data from 600 patients submitted to the registry between 24 March and 20 April 2020, of whom 46% were admitted to hospital and 9% died. The majority (71%) of patients were female, with a median age of 56 years, and the most common diagnosis was rheumatoid arthritis (38%), followed by systemic lupus erythematosus (SLE; 14%), psoriatic arthritis (12%), other spondyloarthropathies (8%), and vasculitis (7%).
Conventional DMARDs (including antimalarial agents) were the most commonly used medication, with 45% of patients using these drugs, while 33% were taking corticosteroids, 18% biologics or Janus kinas (JAK) inhibitors alone, and 21% biologics or JAK inhibitors in combination with conventional DMARDs.
Yazdany reported that the 64 patients receiving corticosteroids at a prednisone-equivalent dose of 10 mg/day or greater had a significant 2.05-fold higher risk for hospital admission than the 403 not taking corticosteroids, and this association remained significant after adjustment for disease activity and smoking. Lower corticosteroid doses, however, were not significantly associated with hospitalization risk.
The presenter noted that there were “fewer hospitalizations” among people treated with biologics or JAK inhibitors alone, and in an adjusted model patients taking tumor necrosis factor (TNF) inhibitors had a significant 60% lower likelihood of hospitalization than non-TNF inhibitor users. There was no association between antimalarial drug use and hospitalization rates.
“We are not yet powered to look at other drug categories but hopefully as the registry grows we’ll be able to do this type of analysis for other specific drugs,” said Yazdany.
The researchers also analyzed the association between rheumatic disease type and hospitalization rates, finding that SLE patients may have a “slightly” elevated risk, but Yazdany noted that the findings are based on small patient numbers at present, and that social determinants of health have a disproportionate impact on those with SLE.
“It’s going to be important for us to untangle [the contributions of] disease, drugs, comorbidities, and social determinants of health, which are so important in this pandemic,” she said.
In accordance with the known risk factors in people without rheumatic diseases, patients with comorbidities – including hypertension, lung disease, diabetes, and chronic kidney disease – had a significantly elevated risk for hospitalization, and older age was also identified as a risk factor.
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