Researchers Look for Factors Linking COVID-19 Deaths Among Patients With RMD

A study of the COVID-19 Global Rheumatology Alliance—a registry of adults with rheumatic and musculoskeletal diseases (RMD) and presumed or confirmed cases of COVID-19 as reported by physicians—revealed that higher rates of death from the pandemic virus are associated with disease severity and with certain types of therapeutic agents.

Among the 3,729 patients in the registry—with a mean age of 57 and 68% female—390 (10.5%) died from COVID-19. When compared to remission or low disease activity, moderate and high disease activity was associated with higher odds of death (1.87, 1.27 to 2.77).

Independent factors associated with these deaths included known risk factors such as age, with patients from 66 to 75 and up at higher risk; sex, with men at greater risk; hypertension combined with cardiovascular disease; and chronic lung disease.

Patients who were being treated for rheumatic diseases with corticosteroids equivalent to >10 mg/day prednisolone rituximab, sulfasalazine, azathioprine, cyclophosphamide, cyclosporin, mycophenolate, or tacrolimus were also found to have higher rates of death from COVID-19. Patients who were taking no disease-modifying antirheumatic drug (DMARD) were also at higher risk of death when compared with patients on methotrexate monotherapy. The authors found that other biological DMARDs were not associated with increased risk of death from COVID-19.

The registry recorded sex, age, smoking status, and comorbid conditions as well as rheumatic disease diagnosis and disease activity for all patients. Patient medications were included as covariates in multivariable logistic regression models, and studies were further partitioned according to rheumatic disease categories.

“Among 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,” the authors concluded.

-Angelique Platas

Resources:

Strangfeld A, Schäfer M, Gianfrancesco MA, et al.  Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis Published online first:  January 27, 2021. doi: 10.1136/annrheumdis-2020-219498