Ann Rheum Dis undefined

PMC: PMC7299648

PMID: 32471903

Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

Patricia Katz+20 authors

^{Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA,}

^{Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK,}

^{National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK,}

^{Instituto de Salud Musculoesquelética, Madrid, Spain,}

^{Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA,}

^{Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France,}

^{APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France,}

^{Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK,}

^{Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal,}

^{Health Research & Policy, Division of Epidemiology and Department of Medicine, Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA,}

^{Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany,}

^{University of Washington, Seattle, Washington, USA,}

^{Crystal Run Healthcare, Middletown, New York, USA,}

^{Irish Children's Arthritis Network (iCAN), Tipperary, Ireland,}

^{Department of Medicine, University of Otago, Wellington, New Zealand,}

^{Boston Children’s Hospital, Boston, Massachusetts, USA,}

^{Harvard Medical School, Boston, Massachusetts, USA,}

^{Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,}

^{Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada,}

^{Healthpartners, St Paul, Minnesota, USA,}

^{Massachusetts General Hospital, Boston, Massachusetts, USA,}

^{Centre for Rheumatology & Department of Neuromuscular Diseases, University College London (UCL), London, UK,}

^{University College London Hospitals (UCLH) National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK,}

^{Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS trust, London, UK,}

^{Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia,}

^{Metro North Hospital & Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia,}

^{Corresponding author.}

^{Contributed equally.}

^{Dr Philip C Robinson, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia;}ua.ude.qu@nosnibor.pilihp

Received 2020 May 4; Revised 2020 May 10; Accepted 2020 May 11.

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Abstract

Objectives

COVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease.

Methods

Case series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed.

Results

A total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed.

Conclusions

We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.

Keywords: tumor necrosis factor inhibitors, arthritis, rheumatoid, lupus erythematosus, systemic, hydroxychloroquine, methotrexate

Key messages

What is already known about this subject?

Data regarding outcomes for people with rheumatological disease and COVID-19 remain scarce and limited to small case series.
Due to underlying immune system dysfunction and the common use of immunosuppressants, there is concern about poorer outcomes in this population and uncertainty about medication management during the pandemic.

What does this study add?

Moderate to high dose glucocorticoids were associated with a higher risk of hospitalisation for COVID-19.
Biologic therapies, NSAIDs and antimalarial drugs like hydroxychloroquine were not associated with a higher risk of hospitalisation for COVID-19.

How might this impact on clinical practice or future developments?

This study demonstrates that most individuals with rheumatological diseases or on immunosuppressive therapies recover from COVID-19, which should provide some reassurance to patients.

Acknowledgments

The authors would like to thank all rheumatology providers who entered data into the registry. See also Appendix 1, Members of the COVID-19 Global Rheumatology Alliance.

Footnotes

Handling editor: Josef S Smolen

Twitter: @pedrommcmachado, @philipcrobinson

MG and KLH contributed equally.

JY, PMM and PCR contributed equally.

Collaborators: on behalf of the COVID-19 Global Rheumatology Alliance (please see online appendix with full list of members).

Contributors: MG, KLH, SA-A, LC, MID, LG, ZI, LJ, PK, SL-T, EFM, SR, GS, JS, AS, LT and KDW contributed to data collection, data quality control, data analysis and interpretation. They drafted, and revised, the manuscript critically for important intellectual content and gave final approval of the version to be published. SB, WC, RG, JSH, JWL, ES, PS and ZSW contributed to the acquisition, analysis and interpretation of the data. They drafted, and revised, the manuscript critically for important intellectual content and gave final approval of the version to be published. JY, PMM and PCR directed the work, designed the data collection methods and contributed to the analysis and interpretation of the data. They drafted, and revised, the manuscript critically for important intellectual content and gave final approval of the version to be published.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Disclaimer: The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance, and do not necessarily represent the views of the American College of Rheumatology (ACR), the European League Against Rheumatism (EULAR) or any other organisation. The views expressed are those of the authors and not necessarily those of the (UK) National Health Service (NHS), the National Institute for Health Research (NIHR) or the (UK) Department of Health.

Competing interests: MG reports grants from National Institutes of Health, NIAMS, outside the submitted work. KLH reports she has received speaker’s fees from AbbVie and grant income from BMS, UCB and Pfizer, all unrelated to this manuscript. KLH is also supported by the NIHR Manchester Biomedical Research Centre. SA-A has nothing to disclose. LC has not received fees or personal grants from any laboratory, but her institute works by contract for laboratories among other institutions, such as AbbVie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, S.A., Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH and UCB Pharma. MD reports no competing interests related to this work. She is supported by grants from the National Institute of Health, Pfizer Independent Grants for Learning and Change, Genentech, Horizon Pharma. She has performed consultant work for Amgen, Novartis, Regeneron/Sanofi unrelated to this work. LG reports personal consultant fees from AbbVie, Biogen, Celgene, Janssen, Eli Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB and grants from Eli Lilly, Mylan, Pfizer, all unrelated to this manuscript. EM reports that LPCDR received support for specific activities: grants from AbbVie, Novartis, Janssen-Cilag, Eli Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work. GS reports no competing interests related to this work. Her work is supported by grants from the National Institutes of Health and Agency for Healthcare Research and Quality. She leads the Data Analytic Center for the American College of Rheumatology, which is unrelated to this work. AS reports grants from a consortium of 13 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Eli Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis and UCB) supporting the German RABBIT register and personal fees from lectures for AbbVie, MSD, Roche, BMS, Pfizer, outside the submitted work. SB reports no competing interests related to this work. He reports non-branded marketing campaigns for Novartis (<US$10 000). RG reports non-financial support from Pfizer Australia, personal fees from Pfizer Australia, personal fees from Cornerstones, personal fees from Janssen New Zealand, non-financial support from Janssen Australia, personal fees from Novartis, outside the submitted work. JSH reports grants from Rheumatology Research Foundation, grants from Childhood Arthritis and Rheumatology Research Alliance (CARRA), personal fees from Novartis, outside the submitted work. ES reports non-financial support from Canadian Arthritis Patient Alliance, outside the submitted work. PS reports personal fees from American College of Rheumatology/Wiley Publishing, outside the submitted work. JY reports personal fees from AstraZeneca, personal fees from Eli Lilly, grants from Pfizer, outside the submitted work. PM reports personal fees from AbbVie, personal fees from Eli Lilly, personal fees from Novartis, personal fees from UCB, outside the submitted work. PR reports personal fees from AbbVie, non-financial support from BMS, personal fees from Eli Lilly, personal fees from Janssen, personal fees from Pfizer, personal fees from UCB, non-financial support from Roche, personal fees from Novartis, outside the submitted work. ZI, LJ, PK, SLT, SR, JFS, LT, KW, WC, JWL and ZSW have nothing to disclose.

Patient and public involvement: Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the 'Methods' section for further details.

Patient consent for publication: Not required.

Ethics approval: The C19-GRA physician registry was determined 'not human subjects research' by the UK Health Research Authority and the University of Manchester, as well as under United States Federal Guidelines assessed by the University of California, San Francisco and patient consent was not required.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement: Request for access to data from the registry should be made to the Data Access and Sharing Committee of the COVID-19 Global Rheumatology Alliance.

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