Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

Author:

Strangfeld AnjaORCID,Schäfer Martin,Gianfrancesco Milena A,Lawson-Tovey Saskia,Liew Jean W,Ljung LottaORCID,Mateus Elsa F,Richez ChristopheORCID,Santos Maria JORCID,Schmajuk Gabriela,Scirè Carlo AORCID,Sirotich Emily,Sparks Jeffrey A,Sufka Paul,Thomas Thierry,Trupin Laura,Wallace Zachary S,Al-Adely Sarah,Bachiller-Corral JavierORCID,Bhana Suleman,Cacoub Patrice,Carmona LoretoORCID,Costello RuthORCID,Costello Wendy,Gossec LaureORCID,Grainger Rebecca,Hachulla EricORCID,Hasseli RebeccaORCID,Hausmann Jonathan SORCID,Hyrich Kimme LORCID,Izadi Zara,Jacobsohn Lindsay,Katz Patricia,Kearsley-Fleet LianneORCID,Robinson Philip CORCID,Yazdany Jinoos,Machado Pedro MORCID

Abstract

ObjectivesTo determine factors associated with COVID-19-related death in people with rheumatic diseases.MethodsPhysician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.ResultsOf 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66–75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.ConclusionAmong people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Funder

American College of Rheumatology

European League Against Rheumatism

Publisher

BMJ

Subject

General Biochemistry, Genetics and Molecular Biology,Immunology,Immunology and Allergy,Rheumatology

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