COVID-19 Rates in Immune-Mediated Inflammatory Disease Patients Resemble General Population

David Saadoun, PhD

The COVID-19 pandemic has raised concerns regarding patients with immune-mediated inflammatory diseases, who are already at higher risk of severe disease due to infection.

A collection of data from 7 studies suggested the risk of COVID-19 in these patient groups is 2 times higher than the general population, but a lack of serology testing may have overestimated the severity.

Investigators, led by Professor David Saadoun, PhD, of Sorbonne Université in Paris, France, found that the prevalence and effects of COVID-19 in patients with immune-mediated inflammatory disease resembled rates in the general population.

Saadoun and team designed the Euro-COVIMID study to assess the seroprevalence of COVID-19 in patients in Europe who have immune-mediated inflammatory disease.

The Study

Investigators used a cross-section study of tertiary referral centers in France, Germany, Italy, Portugal, Spain, and the United Kingdom. The study took place from June to December 2020.

Patients aged 18 years or older with a clinical diagnosis of rheumatoid arthritis, axial spondylarthritis, systemic lupus erythematosus, Sjögren’s syndrome, or giant cell arteritis were included in the study.

The team collected information through questionnaires on demographics, comorbidities, treatments, and disease flare-ups, as well as COVID-19 symptoms.

Investigator’s assessed factors associated with symptomatic COVID-19 by multivariable logistic regression.

Secondary outcomes included incidence of recent disease flares, changes in treatments for underlying disease, and the reasons for treatment changes.

The Results

From June to December 2020, 3136 patients with an immune-mediated inflammatory disease completed the study questionnaire.

Investigators found 992 (32·8%) patients were taking prednisone, with 1645 (54·3%) receiving at least one conventional synthetic disease-modifying antirheumatic drug (DMARD).

In the patient group, 3028 had COVID-19 data, serological data, or both available.

The study included 2239 (73.9%) women and 789 (26.1%) men, with a median age of 58 years old. The median duration of immune-mediated inflammatory disease was 8.7 years.

Investigators found a positive serology test in 166 patients (5.5%; 95% CI, 4.7 – 6.4), out of 3018 patients with serological data available.

Symptomatic COVID-19 occurred in 122 patients (4%; 95% CI, 4.7 – 6.4). In this patient population, 24 (19.7%) were admitted to the hospital and 4 (3.3%) died.

The factors associated with symptomatic COVID-19 included higher concentrations of C-reactive proteins with an odds ratio (OR) of 1.18 (95% CI, 1.05 – 1.33; P = .0063) and a higher number of disease flares with an OR of 1.27 (95% CI, 1.02 – 1.58; P = .03).

The team found the use of biological therapy was linked to reduced risk in patients (OR, 0.51; 95% CI, 0.32 – 0.82; P =.0057). Investigators found at least 1 disease flare up occurred in 654 patients (21.6%).

Treatment changes were also observed in 519 (20.6%) of 2514 patients, with 125 (24.1%) patient treatment changes occurring due to the pandemic.

The team also found that immunosuppressants do not cause harm in susceptibility to and severity of COVID-19 in patients with immune-mediated inflammatory diseases.

According to investigators, the control of the inflammatory activity could be key when dealing with the COVID-19 pandemic.

“As guidelines for management of immune-mediated inflammatory diseases during the pandemic are presented as living documents, our data are useful not only in reaffirming the safety of maintaining DMARDs, but also in estimating the rate of flares and their severity during the outbreak,” investigators wrote.

Conclusion

Investigators concluded the overall seroprevalence and effects of COVID-19 in patients with immune-mediated inflammatory disease resembled the general population.

“These data will help to improve the management of COVID-19 in this patient population, particularly at the time when vaccination strategies start to be widely implemented,” investigators wrote.

The study, “SARS-CoV-2 outbreak in immune-mediated inflammatory diseases: the Euro-COVIMID multicentre cross-sectional study,” was published online in The Lancet Rheumatology.