medwireNews: Two case series of patients with systemic lupus erythematosus (SLE) and SARS-CoV-2 infection explore the association between baseline use of SLE medications and COVID-19 outcomes.
In the first report, a case series published in The Lancet Rheumatology, Yevgeniya Gartshteyn and colleagues from Columbia University Irving Medical Center in New York, USA, describe the experience of 18 patients with SLE and confirmed (n=10) or suspected (n=8) SARS-CoV-2 infection. The majority (89%) of patients were women, with a high representation of Hispanic (50%) and Black (39%) ethnicity, and the average age was 41 years. A total of 83% of patients were taking immunosuppressants as baseline SLE medications, while 72% were taking chloroquine or hydroxychloroquine and 54% corticosteroids.
In all, seven patients (39%) were admitted to hospital, three of whom had severe hypoxemic respiratory failure. Gartshteyn et al say that rates of immunosuppressant use – including methotrexate, azathioprine, and rituximab – “were not different in patients with mild versus severe disease” at the time of hospital admission.
Baseline chloroquine or hydroxychloroquine use was reported in 43% of the seven hospitalized patients, and a further three patients initiated hydroxychloroquine use after hospital admission. The majority (91%) of the 11 patients who were not admitted to hospital were taking chloroquine or hydroxychloroquine.
Gartshteyn and team conclude that “[p]revious intake of immunosuppressants before admission to hospital did not seem to influence the severity of infection.”
In the second study, Carlomaurizio Montecucco and colleagues from Fondazione IRCCS Policlinico San Matteo in Pavia, Italy, evaluated the incidence of COVID-19 in 165 patients with SLE from Northern Italy who took part in a survey. Of these, 12 patients developed COVID-19, including four with confirmed SARS-CoV-2 infection and eight with clinically suspected infection.
The majority (92%) of patients were women, with a median age of 53 years in the confirmed COVID-19 group and 34 years in the suspected COVID-19 group. The most commonly used SLE medication was hydroxychloroquine, used by 75% and 88% of patients in the confirmed and suspected groups, respectively, followed by mycophenolate mofetil (75% and 38%) and glucocorticoids (25% and 38%).
As reported in the Annals of the Rheumatic Diseases, one patient with confirmed COVID-19 was admitted to the intensive care unit for 6 days with acute respiratory distress syndrome. This individual had severe SLE treated with mycophenolate mofetil, hydroxychloroquine, and prednisone prior to developing COVID-19. Montecucco and team say that the remaining 11 patients with confirmed or suspected COVID-19 “had a milder disease course,” and experienced full recovery after a median of 22 days.
Noting that “the role of [hydroxychloroquine] on COVID-19 is a matter of debate,” the authors believe their findings “do not suggest that [hydroxychloroquine] may exert a protective action against the infection.”
However, they caution that “we cannot draw any conclusion, since the concomitant use of other immunosuppressive therapies could have influenced the incidence and course of COVID-19 in our cohort.”
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Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30161-2
Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-217717