medwireNews: Moderate-to-high disease activity may be a risk factor for COVID-19-related death among people with rheumatic diseases, suggests research from the COVID-19 Global Rheumatology Alliance.
The study included 3729 rheumatology patients (average age 57 years; 68% women) with presumed or confirmed COVID-19 who were included in the physician-reported registry between March 24 and July 1, 2020. Most patients were from Europe (62.1%) or North America (29.6%), and the most common diagnosis was rheumatoid arthritis (37.4%) followed by connective tissue diseases other than systemic lupus erythematosus (14.3%), psoriatic arthritis (11.8%), and other spondyloarthropathies (11.6%).
In all, 10.5% of the cohort died over the study period, which the researchers say was “clearly higher than [the mortality rate] reported in the general population in most countries.” However, they note that it may be explained by factors such as reporting biases and testing rates, and therefore “should not be taken as an estimate of the overall death rate among patients with rheumatic diseases and COVID-19”
Multivariable analysis demonstrated that patients with moderate-to-high disease activity had a significant 1.87-fold higher risk for COVID-19 mortality than those in remission or with low disease activity, and this association remained significant when the disease groups were analyzed separately.
Pedro Machado, from University College London in the UK, and fellow researchers report that “most DMARDs were not associated with higher odds of death,” with the “notable exceptions” of rituximab and sulfasalazine, which were associated with a significant 4.04- and 3.60-fold increased risk, respectively. People who were taking glucocorticoids at higher doses (>10 mg/day prednisolone equivalent) had a significant 1.69-fold higher mortality risk than those who were not taking glucocorticoids.
These findings confirm “recent recommendations regarding the importance of disease control in rheumatic diseases in the COVID-19 era,” and highlight “the need for adequate disease control with DMARDs, preferably without increasing the glucocorticoid dosage,” write Machado and team in the Annals of the Rheumatic Diseases.
“Future studies should address the observed association of rituximab and sulfasalazine with poor outcomes,” they add.
The team also found that male sex, older age, and the presence of comorbidities were associated with an elevated risk for COVID-19 mortality, in accordance with known risk factors in the general population.
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