COVID-19 Outcomes Have Improved in Patients with Rheumatic Disease

April Jorge, MD

The clinical outcomes of coronavirus 2019 (COVID-19) in patients with rheumatic or musculoskeletal disease were found to be better among those infected later in the pandemic, in a large comparative cohort study.

April Jorge, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues compared outcomes in cohorts treated in the period from January 20-April 19, and April 20-July 19, 2020.

“We found improved outcomes for patients with rheumatic and musculoskeletal diseases after COVID-19 diagnosis in more recent months of the pandemic compared with earlier months,” Jorge told HCPLive.

“This finding is likely multi-factorial, due to increased testing capacity allowing for detection of miler cases as well as improvements in supportive care and newer treatments,” she said.

Jorge and colleagues identified 8,540 patients with rheumatic or musculoskeletal diseases who were diagnosed with COVID-19 during the 6-month study period, including 2,811 designatedthe early cohort and 5,729 in the late cohort.Their source was the US-based Dataworks network, TriNetX, which they describe as a large federated health research network with real-time updates of electronic health record data that enabled timely analysis.

The groups were matched for demographics, comorbidities, laboratory results, glucocorticoid use and previous hospitalizations.The outcomes, assessed within 30 days of COVID-19 diagnosis, included hospitalization, intensive care unit admission, invasive mechanical ventilation, renal failure and death.

Jorge commented that the study did not evaluate potential differences in the risks of severe outcomes from COVID-19 between patients with more severe, systemic disorders such as systemic lupus erythematosus (SLE) or anti-neutrophilic cytoplasmic autoantibody (ANCA) vasculitis, and those with other rheumatic and musculoskeletal diseases.

“Future studies will need to address this question using larger cohorts, which, unfortunately, should be available soon giving risking case numbers due to the ongoing pandemic,” she observed.

Jorge and colleagues report that in the exposure score matched analysis, risk of hospitalization was lower in the late cohort than in the early cohort (874 [32.4%] vs 1227 [45.4%]; relative risk (RR) 0.71; 95% CI, 0.67-0.76). Also lower in the late cohort were the risks of intensive care unit admission (RR, 0.56; 95% CI 0.47-0.65); mechanical ventilation (RR, 0.39; 95% CI, 0.31-0.49); acute kidney injury (RR, 0.66; 95% CI, 0.59-9.75); renal replacement therapy (RR, 0.53; 95% CI, 0.30-0.96); and death (RR, 0.48; 95% CI, 0.39-0.60).

In the analysis of the hospitalized subgroup, the late cohort also had lower risk of intensive care unit admission, mechanical ventilation and death, but there was not a statistically significant difference between groups in risks of acute kidney injury or of acute renal failure requiring initiation of renal replacement therapy.

“When we restricted our analysis to patients who were hospitalized, and therefore had more similar illness severity, these differences were attenuated, suggesting that some of our observed improvements in the primary analysis could be driven by temporal changes in illness severity at the time of COVID-19 diagnosis,” the investigators wrote.

“Overall, despite improvements in the risks of severe outcomes over time, there continues to be a considerable risk of morbidity and mortality form COVID-19 among patients with rheumatic and musculoskeletal diseases, and we emphasize the need for continued vigilance,” Jorge commented.

The study, "Temporal Trends in Severe COVID-19 Outcomes in Patients with Rheumatic Disease," was published in The Lancet Rheumatology.