Abstract
Aim: To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19.
Methods: People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: 1) not hospitalized, 2) hospitalized with no oxygenation, 3) hospitalized with any ventilation or oxygenation, and 4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications, and disease activity.
Results: A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03 95% CI 1.02-1.04), male sex (1.50, 1.01-2.23), prednisone dose (1-5 mg/d 1.86, 1.20-2.66, 6-9 mg/d 2.47, 1.24-4.86, and ≥10 mg/d 1.95, 1.27-2.99), no current treatment (1.80, 1.17-2.75), comorbidities (e.g. kidney disease 3.51, 2.42-5.09, cardiovascular disease/hypertension 1.69, 1.25-2.29), and moderate or high SLE disease activity (vs. remission; 1.61, 1.02-2.54 and 3.94, 2.11-7.34, respectively) were associated with more severe outcomes. In age and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared to hydroxychloroquine; outcomes were more favorable with methotrexate and belimumab.
Conclusions: More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities, and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.
Methods: People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: 1) not hospitalized, 2) hospitalized with no oxygenation, 3) hospitalized with any ventilation or oxygenation, and 4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications, and disease activity.
Results: A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03 95% CI 1.02-1.04), male sex (1.50, 1.01-2.23), prednisone dose (1-5 mg/d 1.86, 1.20-2.66, 6-9 mg/d 2.47, 1.24-4.86, and ≥10 mg/d 1.95, 1.27-2.99), no current treatment (1.80, 1.17-2.75), comorbidities (e.g. kidney disease 3.51, 2.42-5.09, cardiovascular disease/hypertension 1.69, 1.25-2.29), and moderate or high SLE disease activity (vs. remission; 1.61, 1.02-2.54 and 3.94, 2.11-7.34, respectively) were associated with more severe outcomes. In age and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared to hydroxychloroquine; outcomes were more favorable with methotrexate and belimumab.
Conclusions: More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities, and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.
| Original language | English |
|---|---|
| Journal | Annals of the rheumatic diseases |
| DOIs | |
| Publication status | Published - 16 Feb 2022 |
