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COVID outcomes have improved over time in patients with rheumatic disease

The Lancet Rheumatology
Reuters Health - 26/01/2021 -  A trends analysis shows that COVID-19 outcomes in patients with rheumatic and musculoskeletal diseases improved as the pandemic continued.

"To our knowledge, we provide the first report of improving COVID-19 outcomes, including hospitalization, mechanical ventilation, renal failure, and death, in patients with rheumatic and musculoskeletal diseases in a multicenter US electronic health record database during the ongoing pandemic," the study team writes in The Lancet Rheumatology.

Using TriNetX, a large, multicenter, electronic-health-record network, they compared COVID-19 outcomes in patients with rheumatic disease who were treated early in the pandemic (January 20-April 19) and their peers treated later (April 20-July 19). The early cohort include 2,811 patients and the late cohort had 5,729 patients.

The groups were matched for demographics, comorbid conditions, laboratory results, glucocorticoid use and prior hospitalizations. The outcomes, assessed within 30 days of COVID-19 diagnosis, included hospitalization, intensive-care unit (ICU) admission, invasive mechanical ventilation, renal failure and death.

The risk of hospitalization was 32% in the late cohort versus 45% in the early cohort (relative risk, 0.71; 95% confidence interval, 0.67 to 0.76), report Dr. April Jorge, from Massachusetts General Hospital and Harvard Medical School, and colleagues.

The late cohort was also significantly less apt to need ICU admission (7.9% vs. 14.3%), mechanical ventilation (3.6% vs. 9.1%) or renal-replacement therapy (0.6% vs. 1.2%), to develop acute kidney injury (13.8% vs. 20.7%) or to die (4.5% vs. 9.3%).

Among the hospitalized subgroup, the late cohort had a significantly lower risk of a composite outcome of ICU admission, mechanical ventilation and death (31% vs. 41%), but there were no statistically significant differences in risks of acute kidney injury or need for renal-replacement therapy.

"Early in the pandemic, there were reports of poor outcomes such as mortality and the need for mechanical ventilation for patients with rheumatic diseases. However, there were reports that case-fatality rates from COVID-19 declined over a several month period in the general population," Dr. Jorge noted in email to Reuters Health.

"In this study, we found that severe outcomes from COVID-19 in patients with rheumatic diseases did improve in more recent months compared with the earlier months of the pandemic, which likely indicates improvements in treatment and supportive care as well as more widespread testing," she said.

"However, we also found that the risks of these outcomes remain substantial; in the recent period of the study, the composite outcome of death, mechanical ventilation, and/or ICU admission occurred in nearly 30% of patients with rheumatic and musculoskeletal diseases who were hospitalized with COVID-19, said Dr. Jorge.

"Therefore, we recommend that patients with rheumatic diseases continue to follow precautions to prevent COVID-19 and further treatments are needed," she added.

SOURCE: https://bit.ly/3ollGFY The Lancet Rheumatology, online December 23, 2020.

By Megan Brooks

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