Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study. (December 2021)

• Record Type: Journal Article
• Authors: Sattui, Sebastian E; Conway, Richard; Putman, Michael S; Seet, Andrea M; Gianfrancesco, Milena A; Beins, Kaley; Hill, Catherine; Liew, David; Mackie, Sarah L; Mehta, Puja; Neill, Lorna; Gomez, Gimena; Salinas, Maria Isabel Haye; Maldonado, Federico Nicolas; Mariz, Henrique Ataide; de Sousa Studart, Samia Araujo; Araujo, Nafice Costa; Knight, Ann; Rozza, Davide; Quartuccio, Luca; Samson, Maxime; Bally, Stéphane; Maria, Alexandre TJ; Chazerain, Pascal; Hasseli, Rebecca; Müller-Ladner, Ulf; Hoyer, Bimba F; Voll, Reinhard; Torres, Rita Pinheiro; Luis, Mariana; Ribeirio, Sandra Lucia Euzebio; Al-Emadi, Samar; Sparks, Jeffrey A; Hsu, Tiffany Y-T; D'Silva, Kristin M; Patel, Naomi J; Wise, Leanna; Gilbert, Emily; Almada, Maria Valenzuela; Duarte-García, Alí; Ugarte-Gil, Manuel; Jacobsohn, Lindsay; Izadi, Zara; Strangfeld, Anja; Mateus, Elsa F; Hyrich, Kimme L; Gossec, Laure; Carmona, Loreto; Lawson-Tovey, Saskia; Kearsley-Fleet, Lianne; Schaefer, Martin; Sirotich, Emily; Hausmann, Jonathan S; Sufka, Paul; Bhana, Suleman; Liew, Jean W; Grainger, Rebecca; Machado, Pedro M; Wallace, Zachary S; Yazdany, Jinoos; Robinson, Philip C; Dahou, Brahim; Rath, Eva; Piette, Yves; Devinck, Mieke; Maeyaert, Bea; Machado Ribeiro, Francinne; Euzebio Ribeiro, Sandra Lucia; Pinheiro, Marcelo; Quintana, Rosana; Gómez, Gimena; Roberts, Karen; Baez, Roberto Miguel; Castro Coello, Vanessa; Haye Salinas, María J.; Maldonado, Federico Nicolas; Reyes Torres, Alvaro Andres; Alle, Gelsomina; Tanten, Romina; Maldonado Ficco, Hernán; Nieto, Romina; Gobbi, Carla; Tissera, Yohana; Pisoni, Cecilia; Paula, Alba; Albiero, Juan Alejandro; Schmid, Maria Marcela; Cosatti, Micaela; Gamba, Maria Julieta; Leandro, Carlevaris; Cusa, María Alejandra; German, Noelia; Bellomio, Veronica; Takashima, Lorena; Pera, Mariana; Cogo, Karina; Gálvez Elkin, Maria Soledad; Medina, María Alejandra; Savio, Veronica; Rojas Tessel, Ivana Romina; Perez Alamino, Rodolfo; Werner, Marina Laura; Ornella, Sofía; Casalla, Luciana; de la Vega, Maria; Severina, María; García, Mercedes; Gonzalez Lucero, Luciana; Romeo, Cecilia; Moyano, Sebastián; Barbich, Tatiana; Bertoli, Ana; Baños, Andrea; Petruzzelli, Sandra; Matellan, Carla; Conti, Silvana; Lazaro, Ma. Alicia; Rodriguez Gil, Gustavo Fabián; Risueño, Fabian; Quaglia, Maria Isabel; Scafati, Julia; Cuchiaro, Natalia Lili; Rebak, Jonathan Eliseo; Pineda, Susana Isabel; Calvo, María Elena; Picco, Eugenia; Gallino Yanzi, Josefina; Maid, Pablo; Guaglianone, Debora; Morbiducci, Julieta Silvana; Porta, Sabrina; Herscovich, Natalia; Velasco Zamora, José Luis; Kisluk, Boris; Castaños Menescardi, Maria Sol; Gallo, Rosana; Martire, María Victoria; Maldini, Carla; Goizueta, Cecilia; de la Vega Fernandez, Sabrina Solange; Aeschlimann, Carolina; Subils, Gisela; Ibáñez, Sebastián; Chassin-Trubert, Anne-Marie; Dong, Lingli; Cajas, Lui; Barešic, Marko; Anic, Branimir; Culo, Melanie-Ivana; Pavelic, Tea Ahel; Kovacevic Stranski, Kristina; Karanovic, Boris; Vencovsky, Jiri; Píchová, Marta; Filkova, Maria; Hamoud, Hesham; Vassilopoulos, Dimitrios; Guzman Melgar, Gabriela Maria; So, Ho; Király, Márta; Vojdanian, Mahdi; Balbir-Gurman, Alexandra; Abutiban, Fatemah; Zepa, Julija; Bulina, Inita; Bukauskiene, Loreta; Zaueta, Beatriz; Castillo Ortiz, Angel Alejandro; Zamora Tehozol, Erick; Vega, David; Cervántes Rosete, Diana; Martín Nares, Eduardo; Rodriguez-Reyna, Tatiana Sofia; Rull Gabayet, Marina; Alpízar-Rodríguez, Deshiré; Irazoque, Fedra; Jimenez, Xochitl; Geurts-van Bon, Lenny; Zijlstra, Theo; Hoekstra, Monique; Al-Adhoubi, Nasra; Salim, Babur; Giraldo, Enrique; Salinas, Ariel; Ugarte-Gil, Manuel; Nowakowski, Jaroslaw; Al-Emadi, Samar; Conway, Richard; Flood, Rachael; McCarthy, Geraldine; Felea, Ioana; Filipescu, Ileana; Rednic, Simona; Groseanu, Laura; Tamas, Maria Magdelena; Mlynarikova, Vanda; Skamlova, Martina; Zlnay, Martin; Miceková, Dagmar; Capova, Lubica; Macejova, Zelmira; Štenová, Emoke; Raffayova, Helena; Belakova, Gabriela; Strakova, Eva; Sencarová, Marieta; Žlnayová, Sona; Anna Sabová, Anna; Spisakova, Daniela; Oetterová, Mária; Lukacova, Olga; Bakosova, Martina; Hocevar, Alojzija; de la Torre-Rubio, Natalia; Alegre Sancho, Juan José; Corteguera Coro, Montserrat; Cobeta Garcia, Juan Carlos; Torres Martin, Maria Carmen; Campos, Jose; Gomez Puerta, Jose A; Yardimci, Gozd Kubra; Akar, Servet; Icacan, Ozan Cemal; Çelik, Selda; Vasylets, Viktoriia; Yeoh, Su-Ann; Vandevelde, Claire; Dunt, Sasha; Leeder, Jane; Macphie, Elizabeth; Salerno, Rosaria; Graver, Christine; Williams, Katie; O'Reilly, Sheila; Devine, Kirsty; Tyler, Jennifer; Warner, Elizabeth; Pilcher, James; Patel, Samir; Nikiphorou, Elena; Chadwick, Laura; Jones, Caroline Mulvaney; Harrison, Beverley; Thornton, Lucy; O'Kane, Diana; Fusi, Lucia; Low, Audrey; Horton, Sarah; Jatwani, Shraddha; Baig, Sara; Bajwa, Hammad; Berglund, Vernon; Dahle, Angela; Dorman, Walter; Hargrove, Jody; Hilton, Maren; Lebedoff, Nicholas; Leonard, Susan; Morgan, Jennifer; Pfeifer, Emily; Skemp, Archibald; Wilson, Jeffrey; Wolff, Anne; Cepeda, Eduardo; D'Silva, Kristin; Hsu, Tiffany; Patel, Naomi; Sparks, Jeffrey; Todd, Derrick; Wallace, Zachary; Hare, Denise; Calabrese, Cassandra; Adams, Christopher; Khosroshahi, Arezou; Kilian, Adam; White, Douglas; Winter, Melanie; Fields, Theodore; Siegel, Caroline; Daver, Nicole; Harvey, Melissa; Kramer, Neil; Lamore, Concetta; Hogarty, Suneya; Yeter, Karen; Wise, Leanna; Siddique, Faizah; Ban, Byung; Tanner, Tamar; Ruderman, Eric; Davis, William; Quinet, Robert; Scopelitis, Evangeline; Toribio Toribio, Karen; Webb-Detiege, Tameka; Zakem, Jerald; Abbass, Khurram; Kepecs, Gilbert; Miranda, Lilliam; Guma, Michael; Haikal, Ammar; Mody, Sushama; Mueller, Daric; Jayatilleke, Arundathi; Zell, JoAnn; Bays, Alison; Dao, Kathryn; Fatemeh, Ezzati; Parks, Deborah; Karp, David; Quiceno, Guillermo;
• Is Part Of: Lancet. Volume 3:Number 12(2021)
• Page Start: e855
• Page End: e864
• Publication Date: 2021-12
• Subjects: Rheumatology -- periodicals; 616.72305
• DOI: 10.1016/S2665-9913(21)00316-7
• Languages: English
• ISSNs: 2665-9913

Abstract

Summary: Background: Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-19 outcomes in patients with primary systemic vasculitis or polymyalgia rheumatica. Methods: In this retrospective cohort study, adult patients (aged ≥18 years) diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behçet's syndrome, or other vasculitis) or polymyalgia rheumatica, and were reported to the COVID-19 Global Rheumatology Alliance registry were included. To assess COVID-19 outcomes in patients, we used an ordinal COVID-19 severity scale, defined as: (1) no hospitalisation; (2) hospitalisation without supplemental oxygen; (3) hospitalisation with any supplemental oxygen or ventilation; or (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs), adjusting for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category. Analyses were also stratified by type of rheumatic disease. Findings: Of 1202 eligible patients identified in the registry, 733 (61·0%) were women and 469 (39·0%) were men, and their mean age was 63·8 years (SD 17·1). A total of 374 (31·1%) patients had polymyalgia rheumatica, 353 (29·4%) had ANCA-associated vasculitis, 183 (15·2%) had giant cell arteritis, 112 (9·3%) had Behçet's syndrome, and 180 (15·0%) had other vasculitis. Of 1020 (84·9%) patients with outcome data, 512 (50·2%) were not hospitalised, 114 (11·2%) were hospitalised and did not receive supplemental oxygen, 239 (23·4%) were hospitalised and received ventilation or supplemental oxygen, and 155 (15·2%) died. A higher odds of poor COVID-19 outcomes were observed in patients who were older (per each additional decade of life OR 1·44 [95% CI 1·31–1·57]), were male compared with female (1·38 [1·05–1·80]), had more comorbidities (per each additional comorbidity 1·39 [1·23–1·58]), were taking 10 mg/day or more of prednisolone compared with none (2·14 [1·50–3·04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2·12 [1·49–3·02]). Risk factors varied among different disease subtypes. Interpretation: Among patients with primary systemic vasculitis and polymyalgia rheumatica, severe COVID-19 outcomes were associated with variable and largely unmodifiable risk factors, such as age, sex, and number of comorbidities, as well as treatments, including high-dose glucocorticoids. Our results could be used to inform mitigation strategies for patients with these diseases. Funding: American College of Rheumatology and the European Alliance of Associations for Rheumatology.