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Severe COVID-19 in patients with immune-mediated rheumatic diseases: A stratified analysis from the SORCOM

Alina Boteanu1, Leticia Leon2,3, Silvia Pérez Esteban4

  • 1Rheumatology Department and IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.

Modern Rheumatology
|December 14, 2022
PubMed

Insights

Certain therapies like corticosteroids and rituximab increase COVID-19 severity in rheumatic disease patients. Methotrexate and anti-TNF therapy showed no increased risk for severe coronavirus disease 2019.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Immunology

Background:

  • Patients with immune-mediated rheumatic diseases (IMRD) face risks from infections like COVID-19.
  • Understanding risk factors for severe COVID-19 in IMRD is crucial for patient management.

Purpose of the Study:

  • To evaluate risk factors for severe coronavirus disease 2019 (COVID-19) in patients with IMRD.
  • To stratify risk factors based on systemic autoimmune conditions versus chronic inflammatory arthritis.

Main Methods:

  • Observational, cross-sectional multicentre study.
  • Included 523 patients with severe acute respiratory syndrome coronavirus-2 infection from 10 Madrid rheumatology departments (Feb 2020-May 2021).
  • Logistic regression analyses adjusted for covariates to estimate risk factors for COVID-19 severity (hospital admission or mortality).

Main Results:

  • 35.6% of patients required hospital admission; 7.3% died.
  • Male gender, older age, diabetes, hypertension, and obesity were associated with severe COVID-19.
  • Corticosteroids (>10mg/day), rituximab, sulfasalazine, and mycophenolate use were independently linked to worse outcomes.

Conclusions:

  • Confirms harmful effects of corticosteroids, rituximab, mycophenolate, and sulfasalazine in COVID-19 patients with rheumatic diseases.
  • Methotrexate and anti-tumour necrosis factor (anti-TNF) therapies were not associated with worse COVID-19 outcomes.
  • Severity decreased across pandemic waves; mortality was higher in systemic autoimmune conditions.
Abstract

Keywords:
COVID-19Immune-mediated rheumatic diseaseschronic inflammatory arthritissystemic autoimmune conditionstargeted synthetic/biological disease–modifying antirheumatic drugs

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