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The incidence, clinical characteristics, and outcome of COVID-19 in a prospectively followed cohort of patients with Behçet’s syndrome

Ozcifci et al., Rheumatology International, doi:10.1007/s00296-021-05056-2
Nov 2021  
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Case 4% Improvement Relative Risk Colchicine for COVID-19  Ozcifci et al.  Prophylaxis Does colchicine reduce COVID-19 infections? Prospective study of 1,047 patients in Turkey (Apr 2020 - Apr 2021) No significant difference in cases c19early.org Ozcifci et al., Rheumatology Int., Nov 2021 Favorscolchicine Favorscontrol 0 0.5 1 1.5 2+
Colchicine for COVID-19
5th treatment shown to reduce risk in September 2020, now with p = 0.00000031 from 56 studies.
Lower risk for mortality, ICU, hospitalization, and recovery.
No treatment is 100% effective. Protocols combine treatments.
5,300+ studies for 116 treatments. c19early.org
Prospective analysis of 1,047 Behçet’s syndrome patients in Turkey, showing no significant difference in cases with colchicine use.
Meta analysis of all colchicine studies shows benefit for clinical outcomes but not for viral or case outcomes, consistent with an intervention that may have limited or no direct antiviral effect, but minimizes progression via other mechanisms (for example by aiding the immune system, minimizing immune over-activation, minizing secondary complications, or aiding recovery).
risk of case, 4.0% lower, RR 0.96, p = 0.72, treatment 130 of 616 (21.1%), control 85 of 421 (20.2%), odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ozcifci et al., 25 Nov 2021, prospective, Turkey, peer-reviewed, 13 authors, study period 1 April, 2020 - 30 April, 2021. Contact: eseyahi@yahoo.com.
This PaperColchicineAll
The incidence, clinical characteristics, and outcome of COVID-19 in a prospectively followed cohort of patients with Behçet’s syndrome
Guzin Ozcifci, Tahacan Aydin, Zeynep Atli, Ilker Inanc Balkan, Fehmi Tabak, Mert Oztas, Yesim Ozguler, Serdal Ugurlu, Gulen Hatemi, Melike Melikoglu, Izzet Fresko, Vedat Hamuryudan, Emire Seyahi
Rheumatology International, doi:10.1007/s00296-021-05056-2
Initial case series of small number of patients at the beginning of the pandemic reported a rather guarded prognosis for Behçet's syndrome (BS) patients infected with SARS-CoV-2. In this prospective study, we describe the incidence, clinical characteristics, disease course, management, and outcome in a large cohort of BS patients with laboratory-confirmed infection of SARS-CoV-2. We defined a cohort of 1047 registered BS patients who were aged between 16 and 60 years and seen routinely before the pandemic at the multidisciplinary outpatient clinic. We followed prospectively this cohort from beginning of April 2020 until the end of April 2021. During 13 months of follow-up, of the 1047 (599 M/448 F) patients, 592 (56.5%) were tested for SARS-CoV-2 PCR at least once and 215 (20.5%; 95% CI 0.18-0.23) were tested positive. We observed 2 peaks which took place in December 2020 and April 2021. Of the 215 PCR positive patients, complete information was available in 214. Of these 214, 14 (6.5%) were asymptomatic for COVID-19. In the remaining, the most common symptoms were anosmia, fatigue, fever, arthralgia, and headache. A total of 40 (18.7%) had lung involvement, 25 (11.7%) were hospitalized, 1 was admitted to the intensive care unit while none died. Favipiravir was the most prescribed drug (74.3%), followed by colchicine (40.2%), and hydroxychloroquine (20.1%) in the treatment of COVID-19. After COVID-19, 5 patients (2.3%) were given supplemental O 2 and 31 (14.5%) antiaggregant or anticoagulants. During COVID-19, of the 214 PCR positive patients, 116 (54.2%) decreased the dose of their immunosuppressives or stopped taking completely; 36 (16.8%) experienced a BS flare which was mostly oral ulcers (10.3%). None of the patients reported a thrombotic event. A total of 93 (43.5%) patients reported BS flares after a median 45 days of COVID-19 infection and this was found to be significantly associated with immunosuppressive drug discontinuation. Multiple regression analysis adjusted for age and gender indicated that smoking and using interferon-alpha decreased the likelihood of getting COVID-19. The incidence and severity of COVID-19 did not differ between those who were using colchicine or not. The cumulative incidence of COVID-19 in this prospectively followed cohort of BS patients was almost two folds of that estimated for the general population living in Istanbul, Turkey, however, the clinical outcome of COVID-19 was not severe and there was no mortality. The protective effect of smoking and interferon deserves further investigation. On the other hand, colchicine did not have any positive or negative effect against COVID-19. Significant number of patients flared after COVID-19, however, this was significantly associated with immunosuppressive discontinuation during the infection. Contrary to our previous observations, COVID-19 did not seem to exacerbate thrombotic events during or after the infection. Keywords Outcome • COVID-19 • Behcet's disease •..
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s00296-021-05056-2. Author contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GO, TA, ZA, IIB, FT, MO, YO, SU, GH, MM, IF, VH and ES. The first draft of the manuscript was written by GO and ES and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Authors and Affiliations Guzin
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DOI record: { "DOI": "10.1007/s00296-021-05056-2", "ISSN": [ "0172-8172", "1437-160X" ], "URL": "http://dx.doi.org/10.1007/s00296-021-05056-2", "alternative-id": [ "5056" ], "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "21 October 2021" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "13 November 2021" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "25 November 2021" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Conflict of interest", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "Guzin Ozcifci, Tahacan Aydin, Zeynep Atli, Ilker Inanc Balkan, Mert Oztas, Yesim Ozguler, Melike Melikoglu, Izzet Fresko and Vedat Hamuryudan declare that they have no conflict of interest. Fehmi Tabak, has received honoraria, consulting or speaker fees from GSK, MSD, AbbVie and Gilead. Serdal Ugurlu has received honoraria, consulting or speaker fees from Novartis, Pfizer, Lilly and Celltrion. Gulen Hatemi has received research grant from Celgene, honoraria consulting or speaker fees from AbbVie, Amgen, Celgene, Lilly, Novartis and UCB Pharma. Emire Seyahi has received honoraria, consulting or speaker fees from Novartis, Pfizer, AbbVie and Gilead." }, { "label": "Free to read", "name": "free", "value": "This content has been made available to all." } ], "author": [ { "ORCID": "http://orcid.org/0000-0002-4774-9284", "affiliation": [], "authenticated-orcid": false, "family": "Ozcifci", "given": "Guzin", "sequence": "first" }, { "ORCID": "http://orcid.org/0000-0002-8125-4808", "affiliation": [], "authenticated-orcid": false, "family": "Aydin", "given": "Tahacan", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-2959-0978", "affiliation": [], "authenticated-orcid": false, "family": "Atli", "given": "Zeynep", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-8977-5931", "affiliation": [], "authenticated-orcid": false, "family": "Balkan", "given": "Ilker Inanc", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-8632-2825", "affiliation": [], "authenticated-orcid": false, "family": "Tabak", "given": "Fehmi", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-4077-1374", "affiliation": [], "authenticated-orcid": false, "family": "Oztas", "given": "Mert", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-2082-4715", "affiliation": [], "authenticated-orcid": false, "family": "Ozguler", "given": "Yesim", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-9561-2282", "affiliation": [], "authenticated-orcid": false, "family": "Ugurlu", "given": "Serdal", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-1952-1135", "affiliation": [], "authenticated-orcid": false, "family": "Hatemi", "given": "Gulen", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-0253-8368", "affiliation": [], "authenticated-orcid": false, "family": "Melikoglu", "given": "Melike", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-8914-9690", "affiliation": [], "authenticated-orcid": false, "family": "Fresko", "given": "Izzet", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-6625-1652", "affiliation": [], "authenticated-orcid": false, "family": "Hamuryudan", "given": "Vedat", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-4965-2918", "affiliation": [], "authenticated-orcid": false, "family": "Seyahi", "given": "Emire", "sequence": "additional" } ], "container-title": "Rheumatology International", "container-title-short": "Rheumatol Int", "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2021, 11, 25 ] ], "date-time": "2021-11-25T17:02:46Z", "timestamp": 1637859766000 }, "deposited": { "date-parts": [ [ 2023, 1, 16 ] ], "date-time": "2023-01-16T08:33:32Z", "timestamp": 1673858012000 }, "indexed": { "date-parts": [ [ 2023, 3, 14 ] ], "date-time": "2023-03-14T07:50:44Z", "timestamp": 1678780244501 }, "is-referenced-by-count": 4, "issue": "1", "issued": { "date-parts": [ [ 2021, 11, 25 ] ] }, "journal-issue": { "issue": "1", "published-print": { "date-parts": [ [ 2022, 1 ] ] } }, "language": "en", "license": [ { "URL": "https://www.springer.com/tdm", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2021, 11, 25 ] ], "date-time": "2021-11-25T00:00:00Z", "timestamp": 1637798400000 } }, { "URL": "https://www.springer.com/tdm", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2021, 11, 25 ] ], "date-time": "2021-11-25T00:00:00Z", "timestamp": 1637798400000 } } ], "link": [ { "URL": "https://link.springer.com/content/pdf/10.1007/s00296-021-05056-2.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/article/10.1007/s00296-021-05056-2/fulltext.html", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/content/pdf/10.1007/s00296-021-05056-2.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "page": "101-113", "prefix": "10.1007", "published": { "date-parts": [ [ 2021, 11, 25 ] ] }, "published-online": { "date-parts": [ [ 2021, 11, 25 ] ] }, "published-print": { "date-parts": [ [ 2022, 1 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "key": "5056_CR1", "unstructured": "https://www.worldometers.info/coronavirus/#countries. 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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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