Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry.

Anja Strangfeld ORCID logo; Martin Schäfer; Milena A Gianfrancesco; Saskia Lawson-Tovey; Jean W Liew; Lotta Ljung ORCID logo; Elsa F Mateus; Christophe Richez ORCID logo; Maria J Santos ORCID logo; Gabriela Schmajuk; +28 more... Carlo A Scirè ORCID logo; Emily Sirotich; Jeffrey A Sparks; Paul Sufka; Thierry Thomas; Laura Trupin; Zachary S Wallace; Sarah Al-Adely; Javier Bachiller-Corral ORCID logo; Suleman Bhana; Patrice Cacoub; Loreto Carmona ORCID logo; Ruth Costello ORCID logo; Wendy Costello; Laure Gossec ORCID logo; Rebecca Grainger; Eric Hachulla ORCID logo; Rebecca Hasseli ORCID logo; Jonathan S Hausmann ORCID logo; Kimme L Hyrich ORCID logo; Zara Izadi; Lindsay Jacobsohn; Patricia Katz; Lianne Kearsley-Fleet ORCID logo; Philip C Robinson ORCID logo; Jinoos Yazdany; Pedro M Machado ORCID logo; COVID-19 Global Rheumatology Alliance; (2021) Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Annals of the Rheumatic Diseases, 80 (7). pp. 930-942. ISSN 0003-4967 DOI: 10.1136/annrheumdis-2020-219498
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OBJECTIVES: To determine factors associated with COVID-19-related death in people with rheumatic diseases. METHODS: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. RESULTS: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. CONCLUSION: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.


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