Do rheumatic diseases, long-term glucocorticoids, and immunosuppressant treatment, and vaccination impact the COVID-19 severity? Insight from a retrospective cohort study.

Publisher: Wiley on behalf of the Asia Pacific League of Associations for Rheumatology Country of Publication: England NLM ID: 101474930 Publication Model: Print Cited Medium: Internet ISSN: 1756-185X (Electronic) Linking ISSN: 17561841 NLM ISO Abbreviation: Int J Rheum Dis Subsets: MEDLINE

Original Publication: [Oxford, UK] : Wiley on behalf of the Asia Pacific League of Associations for Rheumatology

COVID-19*/prevention & control ; COVID-19*/epidemiology ; Rheumatic Diseases*/drug therapy ; Rheumatic Diseases*/epidemiology ; Glucocorticoids*/therapeutic use ; Glucocorticoids*/adverse effects ; Immunosuppressive Agents*/adverse effects ; Immunosuppressive Agents*/therapeutic use ; Severity of Illness Index* ; SARS-CoV-2*; Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; Risk Factors ; Aged ; Adult ; China/epidemiology ; Case-Control Studies ; COVID-19 Vaccines/adverse effects ; Vaccination ; Time Factors ; Hospitalization/statistics & numerical data

Objectives: The impact of rheumatic diseases, long-term medication, and vaccination on COVID-19 severity remain insufficiently understood, hindering effective patient management. This study aims to investigate factors influencing COVID-19 severity in Chinese rheumatic patients and to provide real-world evidence for patient care.
Methods: We conducted a retrospective observational study consisting of two cohorts, followed by a nested case-control analysis. The outpatient cohort included non-severe COVID-19 patients, while the inpatient cohort included consecutive severe COVID-19 inpatients. Additionally, rheumatic patients from both cohorts were included for the nested case-control study. Clinical information was obtained from electronic medical records and surveys.
Results: A total of 749 outpatients and 167 inpatients were enrolled. In the outpatient cohort, rheumatic diseases were identified as a risk factor for the severity of dyspnea (No rheumatic disease: OR = 0.577, 95% CI = 0.396-0.841, p = .004), but not for mortality, length of hospitalization, or hospitalization costs in the inpatient cohort. Long-term glucocorticoids use was identified as an independent risk factor for severity of dyspnea in rheumatic patients (OR = 1.814, 95% CI = 1.235-2.663, p = .002), while vaccination and immunosuppressant treatment showed no association. Vaccination was identified as a protective factor against hospitalization due to COVID-19 in patients with rheumatic diseases (OR = 0.031, 95% CI = 0.007-0.136, p < .001), whereas long-term glucocorticoids and immunosuppressant treatment showed no association.
Conclusions: Rheumatic diseases and long-term glucocorticoids use are significant risk factors for COVID-19 severity in the Chinese population, whereas emphasizing the protective effects of vaccines against COVID-19 severity is crucial. Additionally, the investigation provides preliminary support for the concept that long-term immunosuppressant therapy does not necessarily require additional prescription adjustments.
(© 2024 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Luo D, Mei B, Wang P, et al. Prevalence and risk factors for persistent symptoms after COVID‐19: a systematic review and meta‐analysis. Clin Microbiol Infect. 2023;30:328‐335.
Tang J, Song T, Kuang M, Feng Y, Liu G, Liu H. Recent advancements on long COVID in China: a narrative review. Int J Gen Med. 2023;16:2585‐2593.
Dewanjee S, Kandimalla R, Kalra RS, et al. COVID‐19 and rheumatoid arthritis crosstalk: emerging association, therapeutic options and challenges. Cells. 2021;10:3291.
Shankar‐Hari M, Vale CL, Godolphin PJ, et al. Association between administration of IL‐6 antagonists and mortality among patients hospitalized for COVID‐19: a meta‐analysis. JAMA. 2021;326:499‐518.
Wallace B, Washer L, Marder W, Kahlenberg JM. Patients with lupus with COVID‐19: University of Michigan experience. Ann Rheum Dis. 2021;80:e35.
Ferri C, Giuggioli D, Raimondo V, et al. COVID‐19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series. Clin Rheumatol. 2020;39:3195‐3204.
Cordtz R, Lindhardsen J, Soussi BG, et al. Incidence and severeness of COVID‐19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark. Rheumatology (Oxford). 2021;60:I59‐I67.
Felson DT. Comparing the prevalence of rheumatic diseases in China with the rest of the world. Arthritis Res Ther. 2008;10:106.
Zeng QY, Chen R, Darmawan J, et al. Rheumatic diseases in China. Arthritis Res Ther. 2008;10:R17.
Bartoletti M, Azap O, Barac A, et al. ESCMID COVID‐19 living guidelines: drug treatment and clinical management. Clin Microbiol Infect. 2022;28:222‐238.
Agarwal A, Hunt B, Stegemann M, et al. A living WHO guideline on drugs for covid‐19. BMJ. 2020;370:m3379.
Anand ST, Vo AD, La J, et al. Risk of severe coronavirus disease 2019 despite vaccination in patients requiring treatment with immune‐suppressive drugs: a nationwide cohort study of US veterans. Transpl Infect Dis. 2024;26:e14168.
Brooks J, Montgomery A, Dalbeth N, et al. Omicron variant infection in inflammatory rheumatological conditions‐outcomes from a COVID‐19 naive population in Aotearoa New Zealand. Lancet reg Health West Pac. 2023;38:100843.
Kowalski EN, Wang X, Patel NJ, et al. Risk factors and outcomes for repeat COVID‐19 infection among patients with systemic autoimmune rheumatic diseases: a case‐control study. Semin Arthritis Rheum. 2023;63:152286.
Andersen KM, Mehta HB, Palamuttam N, et al. Association between chronic use of Immunosuppresive drugs and clinical outcomes from coronavirus disease 2019 (COVID‐19) hospitalization: a retrospective cohort study in a large US health system. Clin Infect Dis. 2021;73:e4124‐e4130.
Helliwell PS, Ibrahim G. Ethnic differences in responses to disease modifying drugs. Rheumatology (Oxford). 2003;42:1197‐1201.
Chenchula S, Karunakaran P, Sharma S, Chavan M. Current evidence on efficacy of COVID‐19 booster dose vaccination against the omicron variant: a systematic review. J Med Virol. 2022;94:2969‐2976.
Altmann DM, Boyton RJ. COVID‐19 vaccination: the road ahead. Science. 2022;375:1127‐1132.
Hadj HI. Covid‐19 vaccines and variants of concern: a review. Rev Med Virol. 2022;32:e2313.
El‐Shabasy RM, Nayel MA, Taher MM, Abdelmonem R, Shoueir KR, Kenawy ER. Three waves changes, new variant strains, and vaccination effect against COVID‐19 pandemic. Int J Biol Macromol. 2022;204:161‐168.
Wang G, Yao Y, Wang Y, et al. Determinants of COVID‐19 vaccination status and hesitancy among older adults in China. Nat Med. 2023;29:623‐631.
National Health Commission of the People's Republic of China. Diagnosis and treatment protocol for COVID‐19 patients (Tentative 10th Version). Health Care Sci. 2023;2:10–24.
Zanetti A, Carrara G, Landolfi G, et al. Increased COVID‐19 mortality in patients with rheumatic diseases: results from the CONTROL‐19 study by the Italian Society for Rheumatology. Clin Exp Rheumatol. 2022;40:2038‐2043.
Bournia VK, Fragoulis GE, Mitrou P, et al. Different COVID‐19 outcomes among systemic rheumatic diseases: a nation‐wide cohort study. Rheumatology (Oxford). 2023;62:1047‐1056.
Bower H, Frisell T, Di Giuseppe D, et al. Impact of the COVID‐19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study. Ann Rheum Dis. 2021;80:1086‐1093.
Strangfeld A, Schafer 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. 2021;80:930‐942.
Brodin R, van der Werff SD, Hedberg P, et al. The association between pre‐exposure to glucocorticoids and other immunosuppressant drugs with severe COVID‐19 outcomes. Clin Microbiol Infect. 2022;28:1477‐1485.
Andersen KM, Bates BA, Rashidi ES, et al. Long‐term use of immunosuppressive medicines and in‐hospital COVID‐19 outcomes: a retrospective cohort study using data from the national COVID cohort collaborative. Lancet Rheumatol. 2022;4:e33‐e41.
Loarce‐Martos J, Garcia‐Fernandez A, Lopez‐Gutierrez F, et al. High rates of severe disease and death due to SARS‐CoV‐2 infection in rheumatic disease patients treated with rituximab: a descriptive study. Rheumatol Int. 2020;40:2015‐2021.
Schiavetti I, Ponzano M, Signori A, Bovis F, Carmisciano L, Sormani MP. Severe outcomes of COVID‐19 among patients with multiple sclerosis under anti‐CD‐20 therapies: a systematic review and meta‐analysis. Mult Scler Relat Disord. 2022;57:103358.
Medeiros‐Ribeiro AC, Aikawa NE, Saad C, et al. Immunogenicity and safety of the CoronaVac inactivated vaccine in patients with autoimmune rheumatic diseases: a phase 4 trial. Nat Med. 2021;27:1744‐1751.
Silva CA, Medeiros‐Ribeiro AC, Kupa L, et al. Immunogenicity decay and case incidence six months post Sinovac‐CoronaVac vaccine in autoimmune rheumatic diseases patients. Nat Commun. 2022;13:5801.
Zheng YQ, Li HJ, Chen L, Lin SP. Immunogenicity of inactivated COVID‐19 vaccine in patients with autoimmune inflammatory rheumatic diseases. Sci Rep. 2022;12:17955.
Agrawal U, Bedston S, Mccowan C, et al. Severe COVID‐19 outcomes after full vaccination of primary schedule and initial boosters: pooled analysis of national prospective cohort studies of 30 million individuals in England, Northern Ireland, Scotland, and Wales. Lancet. 2022;400:1305‐1320.

BYSYDL2023001-02 Clinical Cohort Construction Program of Peking University Third Hospital; 82271836 National Natural Science Foundation of China (NSFC); 72304007 National Natural Science Foundation of China (NSFC); 7244474 Beijing Natural Science Foundation

Keywords: COVID‐19; glucocorticoids; immunosuppressant; rheumatic diseases; vaccination

0 (Glucocorticoids)
0 (Immunosuppressive Agents)
0 (COVID-19 Vaccines)

Date Created: 20240710 Date Completed: 20240710 Latest Revision: 20240710

20240711

10.1111/1756-185X.15251

38982615