COVID-19 Severity Risk is Not Linked to Rheumatic Disease

Naomi Serling-Boyd, MD

Patients with rheumatic disease do not seem to face an increased risk of severe outcomes due to coronavirus 2019 (COVID-19), according to a new cohort assessment.

In late-breaking data presented at the American College of Rheumatology (ACR) Convergence 2020, a team of investigators from Brigham and Women’s Hospital and Massachusetts General Hospital reported that patients with systemic rheumatic disease do not statistically differ from those without in worsened outcomes of COVID-19, including in hospitalization, intensive care unit (ICU) admission, or death.

The data, collected through mid-July this year, provide a sense of assurance to clinicians and specialists initially concerned and little informed on the measures of risk facing rheumatic patients.

Led by Naomi Serling-Boyd, MD, of Massachusetts General, investigators sought to interpret risk of poor COVID-19 outcomes among patients with rheumatic disease versus those from the general population.

“Filling this knowledge gap is a high priority for patients and providers,” they wrote. “We previously observed a higher risk of mechanical ventilation in patients with rheumatic diseases compared to the general population in a small cohort study early in the pandemic.”

Their cohort study included patients with PCR-confirmed COVID-19 at the multicenter healthcare system, treated between January 30 and July 16. Patients with systemic rheumatic disease were compared to control patients based on characteristic matches of age, sex, and date of COVID-19 diagnosis.

Serling-Boyd and colleagues used a multivariable Cox proportional hazard regression model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for COVID-19 outcomes including ventilation, hospitalization, ICU admission, and death in rheumatic patients versus those without such disease.

Temporal trends in mechanical ventilation among patients with rheumatic disease were observed through a comparison of outcome in an early versus recent cohort using similar methods.

Their assessment included 143 patients with rheumatic disease, and 688 matched comparators. Mean rheumatic disease patient age was 60 years old, with three-fourths (76%) being female, versus mean comparator age of 59 years old and again, 76% being female. The most commonly reported rheumatic diseases included rheumatoid arthritis (31%) and systemic lupus erythematosus (19%).

Comorbidity, as per median Charlson Comorbidity Index (CCI) scores and interquartile range (IQRs) were greater among patients with rheumatic disease (2; IQR, 1-4) versus comparators (0; IQR, 0-2). The most commonly prescribed therapies for patients with COVID-19 and rheumatic disease were glucocorticoids (36%), conventional synthetic disease-modifying antirheumatic drug (DMARD) (31%), biologic DMARD (29%), and hydroxychloroquine (21%).

Without demographic adjustment, investigators observed a heightened risk of mechanical ventilation among patients with rheumatic disease than comparators (HR, 1.75; 95% CI, 1.12-2.74). When adjusting for patient race, smoking status, and CCI, the HR dropped to 1.51 (95% CI, 0.93-2.44).

With similar adjustment, Serling-Boyd and colleagues observed no significantly higher risks for ICU admission (HR 0.87; 95% CI, 0.68-1.11), ICU admission (HR, 1.27; 95% CI, 0.86-1.86), or death (HR, 1.02; 95% CI, 0.53-1.95) in rheumatic patients with COVID-19 versus comparator patients.

Regarding temporal trends, investigators did observe a trend toward improvement in the risk of mechanical ventilation in the recent versus early rheumatic disease cohorts (adjusted HR, 0.44; 95% CI, 0.17-1.12).

“These findings provide reassurance for rheumatic disease patients but close monitoring of rheumatic disease patients with other comorbidities is warranted,” investigators concluded.

The study, “Outcomes of COVID-19 Infection in Patients with Rheumatic Diseases in a Multicenter Healthcare System: A Comparative Cohort Study,” was published online in ACR 2020 Convergence.