COVID-19-Related Deaths in Rheumatic Disease Patients Save

There is a growing body of evidence regarding COVID-19 outcomes (including death) in rheumatic disease patients; analysis of a German registry shows that poor control, rituximab, sulfasalazine and other immunosuppressives could be risk factors for COVID-related death.

The early data from the Global Rheumatology Alliance registry suggested the risk of untoward outcomes (COVID-19 hospitalisation) were higher with older age, presence of comorbidities and higher dosages of glucocorticoids (≥10 mg/day of prednisolone equivalent).

The current study from a German registry included 3729 rheumatic patients (mean age 57 years, 68% female), of whom 10.5% (390) died.

Risk factors associated with COVID-19-related death included:

• Age (66–75 years: OR 3.00; >75 years: OR 6.18)
• Male sex (OR 1.46)
• Comorbidities (hypertension combined with cardiovascular disease (OR 1.89), chronic lung disease (OR 1.68)
• Prednisolone-equivalent dosage >10 mg/day (OR 1.69; vs no glucocorticoid intake).
• Moderate/high disease activity (OR 1.87; remission/low disease activity)
• Rituximab use (OR 4.04)
• Sulfasalazine (OR 3.60)
• Iimmunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus - OR 2.22)
• No DMARD use (OR 2.11; vs methotrexate monotherapy)
• (Other synthetic/biological DMARDs were not associated with COVID-19-related death).

From these data it appears that, as in non-rheumatic individuals, comorbidities significantly increase the risks associated with COVID-19 infection. Moreover,  disease activity and  inadequate disease control with ineffective or no DMARD therapy clearly augments the rheumatic patients risk for COVID-19 related death.

Further study is needed as to the contributory effects of rituximab, sulfasalazine and some immunosuppressants.