Clinical course of Covid-19 in a cohort of patients with Behçet disease
María Correa-Rodríguez, José-Luis Callejas-Rubio, Blanca Rueda-Medina, Raquel Ríos-Fernández, Javier De La Hera-Fernández, Norberto Ortego-Centeno
Medicina Clínica, doi:10.1016/j.medcli.2021.11.009
Objective: The implications of Covid-19 in patients with Behc ¸ et's disease (BD) are unknown. Patients with BD usually take long-term therapy with therapeutic agents that have been tested in Covid-19 patients. We aimed to assess the prevalence of Covid-19 in a cohort of patients with BD and investigate whether those patients with a long-term treatment with colchicine, tumor necrosis factor inhibitors (TNFi) or glucocorticoids are at reduced or increased prevalence of Covid-19 related clinical outcomes. Methods: A retrospective study was conducted among 244 patients with BD (86.1% females; mean age 43.95 ± 11.11 years). Each participant completed an online questionnaire regarding demographics, medical conditions, dispensed colchicine, TNFi or oral glucocorticoids, Covid-19 infection, clinical symptoms and recovery. Results: The prevalence of Covid-19 infection was 14.75%. Regarding dose of colchicine, the presence of ageusia was lower in patients taking 0.5 mg/day of colchicine compared to those taking 1.5 mg/day (p = 0.021). The prevalence of dyspnea was significantly higher in patients taking TNFi compared with those without therapy (p = 0.032). With regards to oral glucocorticoids, no significant differences were found. Conclusions: The prevalence of Covid-19 among patients with BD seems to be higher than that among the general population in Spain. Continuous TNFi therapy might increase the prevalence of worse clinical outcomes such as dyspnea; oral glucocorticoids and colchicine apparently provided no protection against the Covid-19 related clinical outcomes of patients with BD.
Authors' contributions Conceptualization, MCR, JLCR and NORC; Data curation, BRM, RFR and JHF; Formal analysis, MCR and NOC; Methodology, MCR, BRM, NOC; Project administration, MCR and JFH; Supervision, JLCR and NOC; Validation, BRM and RRF; Visualization, BRM and JHF; Writing -original draft, MCR; Writing -review & editing, BRM and NOC. All authors read and approved the final manuscript.
Ethical conduct of research All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained for all participants.
Conflicts of interest The authors declare no conflict of interest.
Appendix
References
Bourguiba, Delplanque, Vinit, Ackermann, Savey et al., Clinical course of COVID-19 in a cohort of 342 familial Mediterranean fever patients with a long-term treatment by colchicine in a French endemic area, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-218707Cheng, Li, Cui, Chen, Shan et al., Efficacy and safety of corticosteroid treatment in patients with COVID-19: a systematic review and meta-analysis, Front Pharmacol,
doi:10.3389/fphar.2020.571156Dursun, Temiz, Özer, Daye, Ataseven, Management of patients with Behc ¸ et's disease during the COVID-19 pandemic, Dermatol Ther,
doi:10.1111/dth.14063Elmas, Demirbas, Bagcıer, Türsen, Atasoy et al., Treatment considerations for Behc ¸ et disease in the era of COVID-19: a narrative review, Dermatol Ther,
doi:10.1111/dth.14507Feldmann, Maini, Woody, Holgate, Winter et al., Trials of anti-tumour necrosis factor therapy for COVID-19 are urgently needed, Lancet,
doi:10.1016/S0140-6736(20)30858-8Gendelman, Amital, Luigi, Watad, Continuous hydroxychloroquine or colchicine therapy does not prevent infection with SARS-CoV-2: insights from a large healthcare database analysis, Autoimmun Rev,
doi:10.1016/j.autrev.2020.102566Gianfrancesco, Hyrich, Hyrich, Al-Adely, Al-Adely et al., Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry, Ann Rheum Dis
Haberman, Axelrad, Chen, Castillo, Yan et al., Covid-19 in immune-mediated inflammatory diseases-case series from New York, N Engl J Med,
doi:10.1056/NEJMc2009567Han, Jiang, Xia, He, Lv et al., COVID-19 in a patient with long-term use of glucocorticoids: a study of a familial cluster, Clin Immunol,
doi:10.1016/j.clim.2020.108413Hatemi, Christensen, Bang, Bodaghi, Celik et al., update of the EULAR recommendations for the management of Behc ¸ et's syndrome, Ann Rheum Dis,
doi:10.1136/annrheumdis-2018-213225Ledford, Coronavirus breakthrough: dexamethasone is first drug shown to save lives, Nature
Lopes, Bonjorno, Giannini, Amaral, Menezes et al., Beneficial effects of colchicine for moderate to severe COVID-19: a randomised, double-blinded, placebo-controlled clinical trial, RMD Open,
doi:10.1136/rmdopen-2020-001455Mancinelli, Bassi, Salcuni, Predisposing and motivational factors related to social network sites use: systematic review, JMIR Form Res,
doi:10.2196/12248Montealegre-Gómez, Garavito, Gómez-López, Rojas-Villarraga, Parra-Medina, Colchicine: a potential therapeutic tool against COVID-19. Experience of 5 patients, Reumatol Clin,
doi:10.1016/j.reuma.2020.05.001Montero, Martínez-Barrio, Serrano-Benavente, González, Rivera et al., Coronavirus disease 2019 (COVID-19) in autoimmune and inflammatory conditions: clinical characteristics of poor outcomes, Rheumatol Int,
doi:10.1007/s00296-020-04676-4Pelechas, Drossou, Voulgari, Drosos, Anti-rheumatic drugs for the fight against the novel coronavirus infection (SARSCoV-2): what is the evidence?, Mediterr J Rheumatol,
doi:10.31138/mjr.31.3.259Sandhu, Tieng, Chilimuri, Franchin, A case control study to evaluate the impact of colchicine on patients admitted to the hospital with moderate to severe covid-19 infection, Can J Infect Dis Med Microbiol,
doi:10.1155/2020/8865954Scarsi, Piantoni, Colombo, Airó, Richini et al., Association between treatment with colchicine and improved survival in a single-centre cohort of adult hospitalised patients with COVID-19 pneumonia and acute respiratory distress syndrome, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217712Singh, Majumdar, Singh, Misra, Role of corticosteroid in the management of COVID-19: a systemic review and a Clinician's perspective, Diabetes Metab Syndr Clin Res Rev,
doi:10.1016/j.dsx.2020.06.054Vivanco-Hidalgo, Molina, Martinez, Ñas, Sánchez-Montalvá et al., Incidence of COVID-19 in patients exposed to chloroquine and hydroxychloroquine: results from a population-based prospective cohort in Catalonia. Spain, Euro Surveill,
doi:10.2807/1560-7917.ES.2021.26.9.2001202Wang, Liu, Shao, Xiaopeng, Su et al., Risk and clinical outcomes of COVID-19 in patients with rheumatic diseases compared with the general population: a systematic review and meta-analysis, Rheumatol Int,
doi:10.1007/s00296-021-04803-9Yousaf, Gayam, Feldman, Zinn, Kolodney, Clinical outcomes of COVID-19 in patients taking tumor necrosis factor inhibitors or methotrexate: a multicenter research network study, J Am Acad Dermatol,
doi:10.1016/j.jaad.2020.09.009Yurttas, Oztas, Tunc, Balkan, Tabak et al., Characteristics and outcomes of Behc ¸ et's syndrome patients with Coronavirus Disease 2019: a case series of 10 patients, Intern Emerg Med,
doi:10.1007/s11739-020-02427-8{ 'indexed': {'date-parts': [[2022, 9, 20]], 'date-time': '2022-09-20T05:24:48Z', 'timestamp': 1663651488371},
'reference-count': 31,
'publisher': 'Elsevier BV',
'issue': '6',
'license': [ { 'start': { 'date-parts': [[2022, 9, 1]],
'date-time': '2022-09-01T00:00:00Z',
'timestamp': 1661990400000},
'content-version': 'tdm',
'delay-in-days': 0,
'URL': 'https://www.elsevier.com/tdm/userlicense/1.0/'}],
'content-domain': { 'domain': ['elsevier.es', 'elsevier.com', 'sciencedirect.com'],
'crossmark-restriction': True},
'published-print': {'date-parts': [[2022, 9]]},
'DOI': '10.1016/j.medcle.2022.08.009',
'type': 'journal-article',
'created': {'date-parts': [[2022, 9, 19]], 'date-time': '2022-09-19T11:28:26Z', 'timestamp': 1663586906000},
'page': '262-267',
'update-policy': 'http://dx.doi.org/10.1016/elsevier_cm_policy',
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': 'Clinical course of Covid-19 in a cohort of patients with Behçet disease',
'prefix': '10.1016',
'volume': '159',
'author': [ {'given': 'María', 'family': 'Correa-Rodríguez', 'sequence': 'first', 'affiliation': []},
{'given': 'José-Luis', 'family': 'Callejas-Rubio', 'sequence': 'additional', 'affiliation': []},
{'given': 'Blanca', 'family': 'Rueda-Medina', 'sequence': 'additional', 'affiliation': []},
{'given': 'Raquel', 'family': 'Ríos-Fernández', 'sequence': 'additional', 'affiliation': []},
{ 'given': 'Javier de la',
'family': 'Hera-Fernández',
'sequence': 'additional',
'affiliation': []},
{'given': 'Norberto', 'family': 'Ortego-Centeno', 'sequence': 'additional', 'affiliation': []}],
'member': '78',
'reference': [ { 'key': '10.1016/j.medcle.2022.08.009_bib0160',
'doi-asserted-by': 'crossref',
'first-page': '665',
'DOI': '10.3389/fimmu.2019.00665',
'article-title': "Immunopathogenesis of Behcet's disease",
'volume': '10',
'author': 'Tong',
'year': '2019',
'journal-title': 'Front Immunol'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0165',
'doi-asserted-by': 'crossref',
'first-page': '1067',
'DOI': '10.3389/fimmu.2019.01067',
'article-title': "Behçet's disease: an overview of etiopathogenesis",
'volume': '10',
'author': 'Leccese',
'year': '2019',
'journal-title': 'Front Immunol'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0170',
'doi-asserted-by': 'crossref',
'first-page': 'e14063',
'DOI': '10.1111/dth.14063',
'article-title': "Management of patients with Behçet's disease during the COVID-19 "
'pandemic',
'volume': '33',
'author': 'Dursun',
'year': '2020',
'journal-title': 'Dermatol Ther'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0175',
'doi-asserted-by': 'crossref',
'first-page': 'e14507',
'DOI': '10.1111/dth.14507',
'article-title': 'Treatment considerations for Behçet disease in the era of COVID-19: a '
'narrative review',
'volume': '34',
'author': 'Elmas ÖF',
'year': '2021',
'journal-title': 'Dermatol Ther'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0180',
'first-page': '80',
'article-title': "COVID-19 and Behçet's disease: clinical case series",
'author': 'Espinosa',
'year': '2021',
'journal-title': 'Ann Rheum Dis'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0185',
'doi-asserted-by': 'crossref',
'first-page': '1567',
'DOI': '10.1007/s11739-020-02427-8',
'article-title': "Characteristics and outcomes of Behçet's syndrome patients with "
'Coronavirus Disease 2019: a case series of 10 patients',
'volume': '15',
'author': 'Yurttaş',
'year': '2020',
'journal-title': 'Intern Emerg Med'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0190',
'first-page': '808',
'article-title': "2018 update of the EULAR recommendations for the management of Behçet's "
'syndrome',
'volume': '77',
'author': 'Hatemi',
'year': '2018',
'journal-title': 'Ann Rheum Dis'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0195',
'doi-asserted-by': 'crossref',
'first-page': '539',
'DOI': '10.1136/annrheumdis-2020-218707',
'article-title': 'Clinical course of COVID-19 in a cohort of 342 familial Mediterranean '
'fever patients with a long-term treatment by colchicine in a French '
'endemic area',
'volume': '80',
'author': 'Bourguiba',
'year': '2021',
'journal-title': 'Ann Rheum Dis'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0200',
'doi-asserted-by': 'crossref',
'first-page': '102566',
'DOI': '10.1016/j.autrev.2020.102566',
'article-title': 'Continuous hydroxychloroquine or colchicine therapy does not prevent '
'infection with SARS-CoV-2: insights from a large healthcare database '
'analysis',
'volume': '19',
'author': 'Gendelman',
'year': '2020',
'journal-title': 'Autoimmun Rev'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0205',
'doi-asserted-by': 'crossref',
'DOI': '10.2807/1560-7917.ES.2021.26.9.2001202',
'article-title': 'Incidence of COVID-19 in patients exposed to chloroquine and '
'hydroxychloroquine: results from a population-based prospective cohort '
'in Catalonia. Spain, 2020',
'volume': '26',
'author': 'Vivanco-Hidalgo',
'year': '2021',
'journal-title': 'Euro Surveill'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0210',
'doi-asserted-by': 'crossref',
'first-page': '371',
'DOI': '10.1016/j.reuma.2020.05.001',
'article-title': 'Colchicine: a potential therapeutic tool against COVID-19. Experience '
'of 5 patients',
'volume': '17',
'author': 'Montealegre-Gómez',
'year': '2020',
'journal-title': 'Reumatol Clin'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0215',
'doi-asserted-by': 'crossref',
'first-page': 'e001455',
'DOI': '10.1136/rmdopen-2020-001455',
'article-title': 'Beneficial effects of colchicine for moderate to severe COVID-19: a '
'randomised, double-blinded, placebo-controlled clinical trial',
'volume': '7',
'author': 'Lopes',
'year': '2021',
'journal-title': 'RMD Open'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0220',
'first-page': '2020',
'article-title': 'A case control study to evaluate the impact of colchicine on patients '
'admitted to the hospital with moderate to severe covid-19 infection',
'author': 'Sandhu',
'year': '2020',
'journal-title': 'Can J Infect Dis Med Microbiol'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0225',
'first-page': '80',
'article-title': 'COVID-19 infection in a patient with FMF: does colchicine have a '
'protective effect',
'author': 'Kobak',
'year': '2021',
'journal-title': 'Ann Rheum Dis'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0230',
'doi-asserted-by': 'crossref',
'first-page': '1286',
'DOI': '10.1136/annrheumdis-2020-217712',
'article-title': 'Association between treatment with colchicine and improved survival in '
'a single-centre cohort of adult hospitalised patients with COVID-19 '
'pneumonia and acute respiratory distress syndrome',
'volume': '79',
'author': 'Scarsi',
'year': '2020',
'journal-title': 'Ann Rheum Dis'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0235',
'doi-asserted-by': 'crossref',
'first-page': '259',
'DOI': '10.31138/mjr.31.3.259',
'article-title': 'Anti-rheumatic drugs for the fight against the novel coronavirus '
'infection (SARSCoV-2): what is the evidence?',
'volume': '31',
'author': 'Pelechas',
'year': '2020',
'journal-title': 'Mediterr J Rheumatol'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0240',
'doi-asserted-by': 'crossref',
'first-page': '137',
'DOI': '10.1007/s40495-020-00225-6',
'article-title': 'Colchicine in COVID-19: an old drug new use',
'volume': '6',
'author': 'Schlesinger',
'year': '2020',
'journal-title': 'Curr Pharmacol Rep'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0245',
'doi-asserted-by': 'crossref',
'article-title': 'Impact of colchicine on mortality in patients with COVID-19: a '
'meta-analysis',
'author': 'Vrachatis',
'year': '2021',
'journal-title': 'Hell J Cardiol',
'DOI': '10.1016/j.hjc.2020.11.012'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0250',
'doi-asserted-by': 'crossref',
'first-page': '2101',
'DOI': '10.1007/s10067-020-05144-x',
'article-title': 'Colchicine may not be effective in COVID-19 infection; it may even be '
'harmful?',
'volume': '39',
'author': 'Cumhur Cure',
'year': '2020',
'journal-title': 'Clin Rheumatol'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0255',
'doi-asserted-by': 'crossref',
'first-page': '571156',
'DOI': '10.3389/fphar.2020.571156',
'article-title': 'Efficacy and safety of corticosteroid treatment in patients with '
'COVID-19: a systematic review and meta-analysis',
'volume': '11',
'author': 'Cheng',
'year': '2020',
'journal-title': 'Front Pharmacol'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0260',
'doi-asserted-by': 'crossref',
'first-page': '108413',
'DOI': '10.1016/j.clim.2020.108413',
'article-title': 'COVID-19 in a patient with long-term use of glucocorticoids: a study of '
'a familial cluster',
'volume': '214',
'author': 'Han',
'year': '2020',
'journal-title': 'Clin Immunol'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0265',
'doi-asserted-by': 'crossref',
'first-page': '971',
'DOI': '10.1016/j.dsx.2020.06.054',
'article-title': 'Role of corticosteroid in the management of COVID-19: a systemic review '
"and a Clinician's perspective",
'volume': '14',
'author': 'Singh',
'year': '2020',
'journal-title': 'Diabetes Metab Syndr Clin Res Rev'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0270',
'doi-asserted-by': 'crossref',
'first-page': '70',
'DOI': '10.1016/j.jaad.2020.09.009',
'article-title': 'Clinical outcomes of COVID-19 in patients taking tumor necrosis factor '
'inhibitors or methotrexate: a multicenter research network study',
'volume': '84',
'author': 'Yousaf',
'year': '2021',
'journal-title': 'J Am Acad Dermatol'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0275',
'doi-asserted-by': 'crossref',
'first-page': '1407',
'DOI': '10.1016/S0140-6736(20)30858-8',
'article-title': 'Trials of anti-tumour necrosis factor therapy for COVID-19 are urgently '
'needed',
'volume': '395',
'author': 'Feldmann',
'year': '2020',
'journal-title': 'Lancet'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0280',
'first-page': '1078',
'article-title': "Criteria for diagnosis of Behcet's disease",
'volume': '335',
'year': '1990',
'journal-title': 'Lancet'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0285',
'doi-asserted-by': 'crossref',
'first-page': '85',
'DOI': '10.1056/NEJMc2009567',
'article-title': 'Covid-19 in immune-mediated inflammatory diseases—case series from New '
'York',
'volume': '383',
'author': 'Haberman',
'year': '2020',
'journal-title': 'N Engl J Med'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0290',
'doi-asserted-by': 'crossref',
'first-page': '859',
'DOI': '10.1136/annrheumdis-2020-217871',
'article-title': 'Characteristics associated with hospitalisation for COVID-19 in people '
'with rheumatic disease: data from the COVID-19 Global Rheumatology '
'Alliance physician-reported registry',
'volume': '79',
'author': 'Gianfrancesco',
'year': '2020',
'journal-title': 'Ann Rheum Dis'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0295',
'doi-asserted-by': 'crossref',
'first-page': '1593',
'DOI': '10.1007/s00296-020-04676-4',
'article-title': 'Coronavirus disease 2019 (COVID-19) in autoimmune and inflammatory '
'conditions: clinical characteristics of poor outcomes',
'volume': '40',
'author': 'Montero',
'year': '2020',
'journal-title': 'Rheumatol Int'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0300',
'doi-asserted-by': 'crossref',
'first-page': '469',
'DOI': '10.1038/d41586-020-01824-5',
'article-title': 'Coronavirus breakthrough: dexamethasone is first drug shown to save '
'lives',
'volume': '582',
'author': 'Ledford',
'year': '2020',
'journal-title': 'Nature'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0305',
'doi-asserted-by': 'crossref',
'first-page': '851',
'DOI': '10.1007/s00296-021-04803-9',
'article-title': 'Risk and clinical outcomes of COVID-19 in patients with rheumatic '
'diseases compared with the general population: a systematic review and '
'meta-analysis',
'volume': '1',
'author': 'Wang',
'year': '2021',
'journal-title': 'Rheumatol Int'},
{ 'key': '10.1016/j.medcle.2022.08.009_bib0310',
'doi-asserted-by': 'crossref',
'first-page': 'e12248',
'DOI': '10.2196/12248',
'article-title': 'Predisposing and motivational factors related to social network sites '
'use: systematic review',
'volume': '3',
'author': 'Mancinelli',
'year': '2019',
'journal-title': 'JMIR Form Res'}],
'container-title': 'Medicina Clínica (English Edition)',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://api.elsevier.com/content/article/PII:S238702062200417X?httpAccept=text/xml',
'content-type': 'text/xml',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://api.elsevier.com/content/article/PII:S238702062200417X?httpAccept=text/plain',
'content-type': 'text/plain',
'content-version': 'vor',
'intended-application': 'text-mining'}],
'deposited': { 'date-parts': [[2022, 9, 19]],
'date-time': '2022-09-19T16:26:14Z',
'timestamp': 1663604774000},
'score': 1,
'resource': {'primary': {'URL': 'https://linkinghub.elsevier.com/retrieve/pii/S238702062200417X'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2022, 9]]},
'references-count': 31,
'journal-issue': {'issue': '6', 'published-print': {'date-parts': [[2022, 9]]}},
'alternative-id': ['S238702062200417X'],
'URL': 'http://dx.doi.org/10.1016/j.medcle.2022.08.009',
'relation': {},
'ISSN': ['2387-0206'],
'subject': ['General Medicine'],
'container-title-short': 'Medicina Clínica (English Edition)',
'published': {'date-parts': [[2022, 9]]},
'assertion': [ {'value': 'Elsevier', 'name': 'publisher', 'label': 'This article is maintained by'},
{ 'value': 'Clinical course of Covid-19 in a cohort of patients with Behçet disease',
'name': 'articletitle',
'label': 'Article Title'},
{ 'value': 'Medicina Clínica (English Edition)',
'name': 'journaltitle',
'label': 'Journal Title'},
{ 'value': 'https://doi.org/10.1016/j.medcle.2022.08.009',
'name': 'articlelink',
'label': 'CrossRef DOI link to publisher maintained version'},
{ 'value': 'https://doi.org/10.1016/j.medcli.2021.11.009',
'name': 'associatedlink',
'label': 'CrossRef DOI link to the associated document'},
{'value': 'article', 'name': 'content_type', 'label': 'Content Type'},
{ 'value': '© 2021 Elsevier España, S.L.U. All rights reserved.',
'name': 'copyright',
'label': 'Copyright'}]}
