Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry
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, Dr Pedro M Machado
Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-219498
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 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 prednisoloneequivalent 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 antirheumatic 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 Key messages What is already known about this subject? ⇒ To date, most available data on outcomes for people with rheumatic diseases infected with SARS-CoV-2 come from single centre or single country case series or from one large international registry; the COVID-19 Global Rheumatology Alliance (GRA) physician registry. ⇒ The first GRA publication identified factors associated with higher odds of COVID-19 hospitalisation, including older age, presence of comorbidities and higher dosages of glucocorticoids (≥10 mg/day of prednisolone equivalent). ⇒ Clinical outcome information on patients with COVID-19 who have rheumatic disease therefore remains limited, particularly with regard to factors associated with COVID-19related death. What does this study add? ⇒ In this analysis of 3729 patients with rheumatic diseases, older age, male sex, and cardiovascular and chronic lung disease were associated with COVID-19-related death. ⇒ Disease-specific factors, namely, moderate/ high disease activity and certain medications (rituximab, sulfasalazine and immunosuppressants (as opposed to immunomodulators..
SUPPLEMENTARY TABLES Missing values imputed via multiple imputation, patient numbers may thus be rounded. Effects significant at level α=0.05 are marked in bold. Patients were excluded from a particular analysis if the medication they received provided ≤ 20 patients for that analysis or if there were no deaths reported for that specific medication. CI, confidence interval; CTD, connective tissue diseases; CVD, cardiovascular disease; DA, disease activity; DMARD, disease modifying antirheumatic drugs; GC, glucocorticoids; IJD, inflammatory joint diseases; IL, interleukin; JIA, juvenile idiopathic arthritis; N, number; OR, odds ratio; SLE, systemic lupus erythematosus; TNF; tumour necrosis factor; tsDMARD, targeted synthetic disease modifying antirheumatic drugs. BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Missing values imputed via multiple imputation, patient numbers may thus be rounded. Effects significant at level α=0.05 are marked in bold. Patients were excluded from a particular analysis if the medication they received provided ≤ 20 patients for that analysis or if there were no deaths reported for that specific medication. CI, confidence interval; CTD, connective tissue diseases; CVD, cardiovascular disease; DA, disease activity; DMARD, disease modifying antirheumatic drugs; GC, glucocorticoids; IJD, inflammatory..
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'abstract': '<jats:sec><jats:title>Objectives</jats:title><jats:p>To determine factors associated with '
'COVID-19-related death in people with rheumatic '
'diseases.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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 '
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'patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated '
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'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 '
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'synthetic/biological DMARDs were not associated with COVID-19-related '
'death.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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 '
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