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Poor disease control: a risk factor for severe COVID-19

Presented By
Prof. Rebecca Grainger, University of Otago, New Zealand
ACR 2020
COVID-19 Global Rheumatology Alliance Registry

Data from the COVID-19 Global Rheumatology Alliance Registry showed that high disease activity is a risk factor for poor outcomes from COVID-19.

“Our registry is a global initiative where cases from Europe are entered by the EULAR and cases in the USA by the ACR,” Prof. Rebecca Grainger (University of Otago, New Zealand) explained [1].

Three analyses were presented during the meeting. The risk of hospitalisation was assessed after the first month of the registry in the European and US cohort, risk factors for death in July in the American cohort, and outcome disparities in the global cohort that included data until August. In the first analysis, 600 cases were included: 277 were hospitalised (46%), 55 died (9%). Most patients suffered from rheumatoid arthritis (RA; 38%) and comorbidities were common. Patients aged >65 years had a 2.55-fold increased risk of hospitalisation. The hospitalisation risk of patients that were treated with a prednisone-equivalent of over 10 mg/day was 2.1-fold elevated. Comorbidity of different organ systems was associated with an up to 3-fold elevated risk of hospitalisation. “It is worth noting that the pre-COVID-19 use of DMARDs or biologics was associated with a reduced risk of hospitalisation,” Prof Grainger said.

In the second analysis, risk factors for death due to a SARS-CoV-2 infection were analysed in 1,324 US cases. In this analysis, Black, Asian American, and Latinx patients had a higher risk of hospitalisation, whereas there was no difference in mortality. Latinx patients had a more than 3-fold elevated risk for ventilatory support.

In the largest analysis, a total of 3,729 patients (two-third from Europe and one-third from the USA) were included. The risk of death from COVID-19 was associated with age, male gender, ever smokers, but the latter only in RA patients, and moderate-to-severe disease activity. COVID-19 fatalities were associated with no DMARD use, both sulfasalazine and rituximab treatment, and therapy with glucocorticoids >10 mg per day. As Prof. Grainger explained, these data reveal some learning points (see Figure). “First, it is important to control disease activity as reduced odds of hospitalisation were seen in patients treated with biologic and targeted systemic DMARDs in analysis 1 and there were higher odds of death in patients with moderate-to-high disease activity in analysis 3,” Prof. Grainer said. Second, therapy with glucocorticoids should be minimised and possibly be <10 mg/day, as higher doses are associated with an increased risk for hospitalisation and death. Due to worse outcome in ethnic minority groups, one should advocate measures to protect these people.

Figure: 5 learning points from International COVID-19 Registries [1]

ts, targeted systemic; b, biologic.

  1. Grainger R, Lessons from the COVID-19 Global Rheumatology Registry: Epidemiology, Risk Factors & Outcomes. ACR Convergence 2020, 5-9 Nov.

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