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. 2021 May;80(5):660-666.
doi: 10.1136/annrheumdis-2020-219279. Epub 2020 Nov 30.

Coronavirus disease 2019 outcomes among patients with rheumatic diseases 6 months into the pandemic

Naomi Serling-Boyd  1   2 , Kristin M D'Silva  1   2   3 , Tiffany Yt Hsu  2   4 , Rachel Wallwork  5 , Xiaoqing Fu  3 , Ellen M Gravallese  2   4 , April M Jorge  1   2   3 , Yuqing Zhang  1   2   3 , Hyon Choi  1   2   3 , Jeffrey A Sparks  2   4 , Zachary S Wallace  6   2   3
Affiliations

Coronavirus disease 2019 outcomes among patients with rheumatic diseases 6 months into the pandemic

Naomi Serling-Boyd et al. Ann Rheum Dis. 2021 May.

Abstract

Objective: In earlier studies, patients with rheumatic and musculoskeletal disease (RMD) who got infected with COVID-19 had a higher risk of mechanical ventilation than comparators. We sought to determine COVID-19 outcomes among patients with RMD 6 months into the pandemic.

Methods: We conducted a cohort study at Mass General Brigham in Boston, Massachusetts, of patients with RMD matched to up to five comparators by age, sex and COVID-19 diagnosis date (between 30 January 2020 and 16 July 2020) and followed until last encounter or 18 August 2020. COVID-19 outcomes were compared using Cox regression. Risk of mechanical ventilation was compared in an early versus a recent cohort of patients with RMD.

Results: We identified 143 patients with RMD and with COVID-19 (mean age 60 years; 76% female individuals) and 688 comparators (mean age 59 years; 76% female individuals). There were no significantly higher adjusted risks of hospitalisation (HR: 0.87, 95% CI: 0.68-1.11), intensive care unit admission (HR: 1.27, 95% CI: 0.86-1.86), or mortality (HR: 1.02, 95% CI: 0.53-1.95) in patients with RMD versus comparators. There was a trend towards a higher risk of mechanical ventilation in the RMD cohort versus comparators, although not statistically significant (adjusted HR: 1.51, 95% CI: 0.93-2.44). There was a trend towards improvement in mechanical ventilation risk in the recent versus early RMD cohort (10% vs 19%, adjusted HR: 0.44, 95% CI: 0.17-1.12).

Conclusions: Patients with RMD and comparators had similar risks of poor COVID-19 outcomes after adjusting for race, smoking and comorbidities. The higher risk of mechanical ventilation in the early RMD cohort was no longer detected in a recent cohort, suggesting improved management over time.

Keywords: autoimmune diseases; epidemiology; health care; outcome assessment.

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Conflict of interest statement

Competing interests: EMG reports editor position at New England Journal of Medicine and royalties from the textbook Rheumatology. HC reports research support from AstraZeneca and consultancy fees from Takeda, Selecta, GlaxoSmithKline, and Horizon. JAS reports research support from Amgen and Bristol-Myers Squibb and consultancy fees from Bristol-Myers Squibb, Gilead, Inova, Janssen, Optum, and Pfizer. ZSW reports research support from Bristol-Myers Squibb and consulting fees from Viela Bio.

Figures

Figure 1
Figure 1
Flow diagram of rheumatic disease. Patients and comparators with COVID-19 infection at Mass General Brigham (MGB). MGB, Mass General Brigham.
Figure 2
Figure 2
Cumulative incidence of mechanical ventilation in patients with COVID-19 and rheumatic disease in the recent (n=68) vs early (n=75) cohorts.
Figure 3
Figure 3
Cumulative incidence of hospitalisation in patients with COVID-19 and rheumatic disease in the recent (n=68) vs early (n=75) cohorts.
See this image and copyright information in PMC

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