A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases

BMC Rheumatology

K. N. Sangeetha¹  Vikram Haridas²  Chethana Dharmapalaiah³  Vikramraj Jain⁴  Padmanabha Shenoy⁵  S. Chandrashekara⁶  S. Nagaraj⁷  Benzeeta Pinto⁸  Vineeta Shobha⁸  Ramya Janardana⁸  K. Chanakya⁸  C. Srinivasa⁹  Ramaswamy Subramanian^1,10  Vijay K. Rao^1,11  Yogesh Preet Singh^1,11  Abhishek Patil^1,11  Manisha Daware^1,12  Sharath Kumar^1,13  Shweta Singhai^1,14  Ramesh Jois^1,15  B. G. Dharmanand^1,15 

[1] Anagha Hospital;Arthritis Superspeciality Centre;Aster CMI;Bhagwan Mahaveer Jain Hospital;CARE Hospital;ChanRe Rheumatology and Immunology Centre;Columbia Asia;Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital;Fortis Hospital;JSS Medical College;Manipal Hospital;Narayana Health City;OARC;Sakra Hospital;Vikram Hospital;

关键词: Autoimmune rheumatic diseases;    SARS-CoV-2 infection;    Risk factors;    Outcome;    Hydroxychloroquine;    Glucocorticoid;   

DOI  :  10.1186/s41927-022-00264-0

来源: DOAJ

【 摘 要 】

Abstract Background We conducted this study to identify the influence of prolonged use of hydroxychloroquine (HCQ), glucocorticoids and other immunosuppressants (IS) on occurrence and outcome of COVID-19 in patients with autoimmune rheumatic diseases (AIRDs). Methods This was a prospective, multicenter, non-interventional longitudinal study across 15 specialist rheumatology centers. Consecutive AIRD patients on treatment with immunosuppressants were recruited and followed up longitudinally to assess parameters contributing to development of COVID-19 and its outcome. Results COVID-19 occurred in 314 (3.45%) of 9212 AIRD patients during a median follow up of 177 (IQR 129, 219) days. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19. Glucocorticoids in moderate dose (7.5–20 mg/day) conferred higher risk (RR = 1.72) of infection. Among the IS, Mycophenolate mofetil (MMF), Cyclophosphamide (CYC) and Rituximab (RTX) use was higher in patients with COVID 19. However, the conventional risk factors such as male sex (RR = 1.51), coexistent diabetes mellitus (RR = 1.64), pre-existing lung disease (RR = 2.01) and smoking (RR = 3.32) were the major contributing risk factors for COVID-19. Thirteen patients (4.14%) died, the strongest risk factor being pre-existing lung disease (RR = 6.36, p = 0.01). Incidence (17.5 vs 5.3 per 1 lakh (Karnataka) and 25.3 vs 7.9 per 1 lakh (Kerala)) and case fatality (4.1% vs 1.3% (Karnataka) and 4.3% vs 0.4% (Kerala)) rate of COVID-19 was significantly higher (p < 0.001) compared to the general population of the corresponding geographic region. Conclusions Immunosuppressants have a differential impact on the risk of COVID-19 occurrence in AIRD patients. Older age, males, smokers, hypertensive, diabetic and underlying lung disease contributed to higher risk. The incidence rate and the case fatality rate in AIRD patients is much higher than that in the general population.

【 授权许可】

Unknown