Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry.

Abstract

OBJECTIVES:

To determine factors associated with COVID-19-related death in people with rheumatic diseases.

METHODS:

Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.

RESULTS:

Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.

CONCLUSION:

Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

• Authors: Anja Strangfeld, Martin Schäfer, Milena A Gianfrancesco, Saskia Lawson-Tovey, Jean W Liew, Lotta Ljung, Elsa F Mateus, Christophe Richez, Maria J Santos, Gabriela Schmajuk, Carlo A Scirè, Emily Sirotich, Jeffrey A Sparks, Paul Sufka, Thierry Thomas, Laura Trupin, Zachary S Wallace, Sarah Al-Adely, Javier Bachiller-Corral, Suleman Bhana, Patrice Cacoub, Loreto Carmona, Ruth Costello, Wendy Costello, Laure Gossec, Rebecca Grainger, Eric Hachulla, Rebecca Hasseli, Jonathan S Hausmann, Kimme L Hyrich, Zara Izadi, Lindsay Jacobsohn, Patricia Katz, Lianne Kearsley-Fleet, Philip C Robinson, Jinoos Yazdany, Pedro M Machado, COVID-19 Global Rheumatology Alliance
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 80 Issue 7 Pg. 930-942 (07 2021) ISSN: 1468-2060 [Electronic] England
• PMID: 33504483 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Antirheumatic Agents
• Glucocorticoids

Topics

• Aged
• Antirheumatic Agents (therapeutic use)
• COVID-19 (complications, mortality)
• Comorbidity
• Female
• Global Health (statistics & numerical data)
• Glucocorticoids (therapeutic use)
• Humans
• Male
• Middle Aged
• Odds Ratio
• Registries
• Rheumatic Diseases (mortality, virology)
• Rheumatology (statistics & numerical data)
• SARS-CoV-2