April Jorge, MD: Improved COVID-19 Outcomes for Patients With Rheumatic Disease

Rheumatology Network recently covered a study titled “Temporal trends and severe COVID-19 outcomes in patients with rheumatic disease.” Investigators used real-world data from the TriNetX global health research network to follow approximately 8500 patients with rheumatic and musculoskeletal diseases who had been diagnosed with coronavirus 2019 (COVID-19). They split the group into two cohorts: the first 90 days (beginning in January and ending in April) and the subsequent 90 days (from April through July) to determine how this immunocompromised group fared as the pandemic evolved. They discovered that the incidences of severe complications related to COVID-19 had actually significantly decreased in the later cohort when compared to the first group.

This week, we sat down for an interview with study author April Jorge, MD, with Massachusetts General Hospital, to discuss the findings of the study, her interpretations of the data, and what this may mean for patients with rheumatic disease moving forward in the COVID-19 pandemic.

Rheumatology Network: Hi, Dr Jorge, thank you for joining us. My first question is, what initially sparked your interest in comparing the outcomes of COVID-19 patients with rheumatic and musculoskeletal diseases as the pandemic has progressed?

April Jorge, MD: Yes, thank you. So as the pandemic has progressed, we became really interested in looking at the outcomes for patients with rheumatic diseases and musculoskeletal diseases, and whether the outcomes have changed over time. And this was really driven by a lot of interests that patients with- people with rheumatic diseases have, and their family members, and their doctors and other treating providers have been wondering. You know, what are the risks of severe outcomes if these patients were to have COVID-19. And earlier on in the pandemic there were a lot of reports that patients with rheumatic musculoskeletal diseases might be at a higher risk of severe outcomes in general population. You're more likely to be hospitalized or require mechanical ventilation. And what we wanted to look at, you know, whether or not those outcomes would change over time as testing for the virus became more available, and as treatments and supportive care potentially had improved.

RN: Were you surprised by the results of the study?

AJ: We were not particularly surprised by the results of this study. We were like pleasantly surprised that outcomes had improved over time in these patients. But we had seen data more in the general population scale, looking at the case fatality rate from COVID-19 that seemed to be improving over time, so we wanted to look specifically at patients with rheumatic diseases. And so we were happy to see that outcomes such as mortality had also improved over time.

RN: What do you think made the biggest difference in the improved outcomes for patients in the later cohort?

AJ: That's a great question. Regarding what was what had the biggest impact on the improved outcomes over time. So I do think that there was more than one factor. You know, I do think there is a component of the fact that as testing became more widely available, we're able to diagnose people who may not have as severe of an infection. We further looked at a sub-population of people who were hospitalized with their COVID-19 infection, and of those patients, probably less likely to be just a factor of testing and diagnosing more people because in that group, we still saw improved outcomes over time, from the early to the late cohort. I do think that a driving factor for the findings was that, you know, there have been improvements and supportive care, and in treatment, and we didn't really look specifically at all of the different treatments each patient received. But I do think that there have been trends over time and new treatments that have become available.

RN: Why do you think the use of certain treatments, such as hydroxychloroquine, decreased in the later cohort? Was it because the symptoms were milder? Or was it because the way doctors were treating the patients had evolved over time?

AJ: Oh, yeah, that's a great question. I do think that we did observe that hydroxychloroquine use did decline over time. And I do think that had to do with the way the doctors were treating patients. Earlier on in the pandemic, there was a lot of hope that maybe hydroxychloroquine could be beneficial for COVID-19 outcomes, but then much more data came up over time, showing that unfortunately, that isn't the case and hydroxychloroquine doesn't impact that not to improve COVID-19 outcomes. So I think that it was just used less often to treat people with COVID-19 later on.

RN: What do patients with rheumatic diseases need to know about their increased risks of severe complications as the pandemic continues?

AJ: Yes. You know, it's definitely very important for patients with rheumatic diseases, to think about the risks of COVID-19 and its severe outcomes. We know the risk is still substantial, including being hospitalized requiring, mechanical ventilation, kidney failure, even death. So I think that patients really need to know to stay vigilant and follow all the practices, and the CDC and other guidance, and wearing masks and hand washing frequently, social distancing. It's still very important to practice all of these behaviors to try to prevent infections, and hopefully receive vaccines as soon as they're available, so that we can really improve outcomes and prevent these bad events from happening.

RN: Do does your team plan on doing any further research on this topic in the future?

AJ: Yes, we definitely are interested in continuing to pursue further research in this topic. You know, for this study, due to the numbers of patients with COVID-19, we kind of combined patients with rheumatic and musculoskeletal diseases, looking at people with lupus and rheumatoid arthritis, psoriatic arthritis kind of together. And now, unfortunately, we have a lot more patients that have continued to be diagnosed, so the cohorts have grown. Now we intend to look at outcomes within each individual rheumatic disease, like for lupus alone, for instance, or can compare outcomes amongst the different diseases. And we're also interested in looking at just disparities like race, ethnicity, things like that.

RN: Is there anything else that you would like to add before we wrap this up?

AJ: No, I thank you for the opportunity for highlighting our work. And I appreciate the opportunity.

RN: Thank you, Dr. Jorge. I appreciate you taking the time to speak with me today.