Risks for severe COVID-19 outcomes in patients with rheumatic disease 'remain substantial'
Although the risk for severe COVID-19 outcomes in patients with rheumatic and musculoskeletal disease has lowered, it is nonetheless still significant, according to data published in The Lancet Rheumatology.
“Some studies found higher odds of respiratory failure requiring mechanical ventilation in patients with rheumatic and musculoskeletal diseases than in the general population, and two times higher odds of hospitalization in patients with rheumatic and musculoskeletal diseases on prednisone doses above 10 mg daily than those not on prednisone, whereas other studies have not shown higher incidence or severity of COVID-19 in patients with rheumatic and musculoskeletal diseases than in the general population,” April Jorge, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote.
“Although these early reports provide insight into the impact of the pandemic on patients with rheumatic and musculoskeletal diseases during the initial crisis phase, over the subsequent 6 months, there have been improvements in testing capacity, supportive care (e.g., prone positioning), and treatments (eg, remdesivir and dexamethasone) for COVID-19, leading to a reduction in the case-fatality rate in the general population and speculation that other COVID-19 outcomes might have also improved over time,” they added. “However, temporal trends in COVID-19 outcomes have not been quantified in patients with rheumatic and musculoskeletal diseases.”
To examine time trends regarding COVID-19 outcomes among patients with rheumatic and musculoskeletal diseases throughout the pandemic, Jorge and colleagues conducted a comparative cohort study of TriNetX, a large, multicenter electronic health record network. Using this database, the researchers compared patients with rheumatic and musculoskeletal diseases who were diagnosed with COVID-19 during their first 90 days of the pandemic — Jan. 20, 2020, to April 19, 2020 — to those diagnosed during the second 90 days — April 20, 2020, to July 19, 2020.
For the purposes of this study, Jorge and colleagues defined rheumatic and musculoskeletal diseases as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, systemic sclerosis, dermatomyositis, polymyositis, Sjögren's syndrome, other systemic connective tissue diseases, polymyalgia rheumatica, gout and systemic vasculitis, including antineutrophil cytoplasmic antibody-associated vasculitis, Behçet's disease, polyarteritis nodosa and giant cell arteritis.
In all, the researchers identified 2,811 patients diagnosed with COVID-19 during the first 90 days, and 5,729 diagnosed in the second 90 days, matched 1:1 based on demographics, comorbidities, laboratory results, glucocorticoid use, and previous hospitalizations. Outcomes were assessed within 30 days of COVID-19 diagnosis and included hospitalization, ICU admission, invasive mechanical ventilation, renal failure and death. The researchers also performed a subgroup analysis of patients who were hospitalized for COVID-19.
According to the researchers, in an exposure score matched analysis, the risk for hospitalization was lower in the later cohort than in the earlier cohort (RR = 0.71; 95% CI, 0.67-0.76). The risks for 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, 0.59-0.75), renal replacement therapy (RR = 0.53; 95% CI, 0.30-0.96) and death (RR = 0.48; 95% CI, 0.39-0.6) were also lower in the later cohort.
Among the hospitalized subgroup, the risk for the composite outcome of intensive care unit admission, mechanical ventilation and death was also lower in the later cohort than in the earlier cohort (RR = 0.74; 95% CI, 0.67-0.83).
“We have shown lower risks of respiratory failure, renal failure, and death after COVID-19 diagnosis in patients with rheumatic and musculoskeletal diseases in more recent months compared with the earlier months of the ongoing pandemic in the USA,” Jorge and colleagues wrote. “However, risks of severe COVID-19 outcomes remain substantial. Major improvements in prevention and treatment are urgently needed to reduce the overall burden of COVID-19 among patients with rheumatic and musculoskeletal diseases in the USA.”