Unvaccinated Patients With Rheumatic Diseases Risked Severe COVID-19

Risk factors associated with severe COVID-19 among people with rheumatic diseases (RDs) who were not vaccinated against the virus were similar throughout the varying ‘epochs’ of the pandemic, researchers reported in Arthritis Care & Research.

“Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates,” the authors wrote. “The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types.”

The authors also noted that approximately one-third of the global population had not received a COVID-19 vaccine at the time of publication.

Of the 19,256 unvaccinated people with RDs and COVID-19 included in the study, older people, men, patients with multiple comorbidities, and those who used glucocorticoids, had greater disease activity, or lived in lower HDI regions experienced the worse outcomes across the various pandemic epochs, the investigators found.

“For those with rheumatoid arthritis, sulfasalazine and B-cell–depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes,” they reported. Among patients with connective tissue disease or vasculitis, B-cell–depleting therapy was associated with worse outcomes.

“Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study,” the authors concluded.

Reference:

Yazdany J, Ware A, Wallace ZS, et al. Impact of risk factors on COVID-19 outcomes in unvaccinated people with rheumatic diseases: a comparative analysis of pandemic epochs using the COVID-19 Global Rheumatology Alliance Registry. Arthritis Care Res. 2024;76(2):274-287