medwireNews: The proportion of people with rheumatic and musculoskeletal diseases (RMDs) experiencing severe COVID-19 has declined since the beginning of the pandemic, particularly during the recent Omicron wave, US researchers report.
“These findings suggest that advances in COVID-19 prevention, diagnosis and treatment have contributed to improved outcomes” among patients with RMDs, in line with findings in the general population, say Jeffrey Sparks (Brigham and Women’s Hospital, Boston, Massachusetts) and co-authors in the Annals of the Rheumatic Diseases.
They caution, however, that some RMD patients “continue to experience severe disease, especially those on immunosuppressives known to blunt the response to vaccine and infection, as well as those with other serious comorbidities.”
The team carried out a temporal analysis of electronic medical records of 1449 patients in the Boston area with RMDs and a confirmed SARS-CoV-2 infection between March 2020 and January 2022. Almost three-quarters of these people were in remission or had low disease activity at the time of developing COVID-19; methotrexate was the most frequently used DMARD (22.0%), followed by antimalarials (21.7%) and tumor necrosis factor inhibitors (20.2%), while 9.2% of patients were on rituximab.
In all, 27.5% of patients experienced severe COVID-19 – a composite outcome of hospitalization or death – over the course of the study period. This proportion declined from 45.6% during the early phase of the pandemic (March–June 2020) to 29.3–33.3% in the early treatment (July 2020–January 2021) and early vaccination (February–June 2021) periods, decreasing further to 20.9% during the subsequent period characterized by additional vaccination and a wave of infection with the Delta variant (July–December 2021). The rate was lowest, at 14.7%, during the initial wave of infection with the Omicron variant (December 2021–January 2022).
Multivariable analysis adjusted for age, sex, and race demonstrated that infection during the latest period in the study was associated with a significant 71% reduced risk for severe COVID-19 relative to infection during the earliest period, indicating “substantial improvements” in outcomes over time, say Sparks et al.
The researchers note that “[d]espite these improvements, the absolute number of cases of severe COVID-19 [during the Omicron period] was similar to that observed in other waves,” indicating that infection during this time still “had a substantial impact on patients with [RMDs] and the healthcare systems caring for them,” they add.
In accordance with previous studies, the authors found that vaccination was associated with less severe COVID-19, with a higher proportion of severe versus nonsevere cases occurring in individuals who were unvaccinated at the time of infection (78.4% of 399 vs 59.5% of 1050).
Therefore, even though the majority of patients in the study “were on immunosuppressive treatments previously associated with blunted vaccine responses” and may have an elevated risk for breakthrough infection, Sparks and team say that “vaccination provided important benefits for many of these patients.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group
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