Comorbidity and Drugs Drive COVID-19 Severity and Survival in Rheumatic Disease Save

While comorbidities are associated with severe COVID-19 infection, it appears they also influence severity and survival in rheumatic disease (RMD), according to a a French cohort study,

Analysis of a French RMD cohort with SARS-CoV-2 infection analyzed the effect of inflammatory rheumatic and musculoskeletal diseases (iRMD) and therapies on COVID outcomes.

They looked at rates of severe disease, deathand hospitalization for COVID-19 in those with and without iRMD.

The cohort included 694 RMD adults with COVID-19:

• 438 (63%) developed mild (not hospitalised) disease
• 169 (24%) moderate (hospitalised non-intensive care unit (ICU) disease
• 87 (13%) had severe (ICU/deceased) disease.

Significant predictors of severe outcomes (ICU, death) included age (OR=1.08), female gender (OR=0.45), high BMI (OR=1.07), hypertension (OR=1.86), and use of corticosteroids (OR=1.97), mycophenolate mofetil (OR=6.6), or rituximab (OR=4.21).

Compared to matched hospitalised patients with non-iRMD-COVID-19 patients, there was a higher risk of mortality associated with hospitalised patients with iRMD-COVID-19 (OR 1.45;  0.87–2.42).

While RMD patients are not at higher risk to get COVID-19 infection, this French cohort analysis shows that when RMD patients become COVID-19 infected, the presence of comorbidities (same as the the general population - age, male gender, obesity, hypertension) may drive severity and mortality risk.

Moreover, when matched for common comorbidities, the population with iRMD may not have more frequent death compared with the population with non-iRMD.

Lastly, the use of certain RMD drugs - corticosteroids (regardless of dose), MMF and RTX (but not methotrexate, or tumour necrosis factor alpha and interleukin-6 inhibitors) can worsen COVID-19 outcomes.