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COVID-19-Related Deaths in Rheumatic Disease Patients

Mar 11, 2021 11:41 am

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.

Disclosures
The author has no conflicts of interest to disclose related to this subject

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