Autoimmune Inflammatory Rheumatic Diseases, High-Dose Corticosteroids Linked to Poor COVID-19 Outcomes

Patients with autoimmune inflammatory rheumatic diseases had an increased risk of testing positive for SARS-CoV-2 and worse clinical outcomes of COVID-19, including death, according results from to a South Korean cohort study published in The Lancet Rheumatology.¹ Moreover, patients taking a high dose of systemic corticosteroids had a greater risk of these outcomes than those not taking systemic corticosteroids, while disease-modifying antirheumatic drugs (DMARDs) did not increase the risk of these outcomes.

“Clinicians and patients should be aware that those with autoimmune inflammatory rheumatic diseases might have an increased risk of SARS-CoV-2 infection, severe COVID-19, and COVID-19-related death,” stated Seung Won Lee, MD, PhD, Sejong University College of Software Convergence in Seoul, South Korea, and colleagues. “Patients with an autoimmune inflammatory rheumatic disease receiving a high dose of a systemic corticosteroid should be considered as particularly vulnerable to SARS-CoV-2 infection and developing severe disease; therefore, clinicians should be cautious in determining care for such patients amid the COVID-19 pandemic.”

In this nationwide cohort study, Lee and colleagues used data from a South Korean national health insurance claims-based database to analyze all patients older than 20 years who underwent SARS-CoV-2 RT-PCR testing between January 1 and May 30, 2020 and had completed a general health examination. Of the 133,609 patients, 54% were female, 3.3% were positive for SARS-CoV-2, and 6.2% were diagnosed with autoimmune inflammatory rheumatic diseases. Patients were matched with those without autoimmune inflammatory rheumatic diseases for a comparison.

Patients with an autoimmune inflammatory rheumatic disease, mainly inflammatory arthritis and connective tissue diseases, showed an increased likelihood of testing positive for SARS-CoV-2 (adjusted OR 1.19, 95% CI 1.03–1.40; p=0.026), severe COVID-19 outcomes, which included the requirement of oxygen therapy, intensive care unit admission, application of invasive ventilation, or death, (1.26, 1.02–1.59; p=0.041), and COVID-19-related death (1.69, 1.01–2.84; p=0.046).

Treatment with DMARDs were not associated with COVID-19-related outcomes. Patients receiving a high dose (≥10 mg per day) of systemic corticosteroids had an increased chance of a positive SARS-CoV-2 test (adjusted OR 1.47, 95% CI 1.05–2.03; p=0.022), severe COVID-19 outcomes (1.76, 1.06–2.96; p=0.031), and COVID-19-related death (3.34, 1.23–8.90; p=0.017).

“Because we used the dataset that reflected the initial period of the pandemic in South Korea, caution should be exercised when generalizing our results to the current situation,” the authors concluded.

Reference:

Shin YH, Shin JI, Moon SY, et al. Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study [published online ahead of print, 2021 Jun 18]. Lancet Rheumatol. 2021;10.1016/S2665-9913(21)00151-X. doi:10.1016/S2665-9913(21)00151-X