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. 2022 Jul;81(7):970-978.
doi: 10.1136/annrheumdis-2021-221636. Epub 2022 Feb 16.

Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance

Manuel Francisco Ugarte-Gil  1   2 , Graciela S Alarcón  3   4 , Zara Izadi  5   6 , Ali Duarte-García  7   8 , Cristina Reátegui-Sokolova  2   9 , Ann Elaine Clarke  10 , Leanna Wise  11 , Guillermo J Pons-Estel  12   13 , Maria Jose Santos  14   15 , Sasha Bernatsky  16 , Sandra Lúcia Euzébio Ribeiro  17 , Samar Al Emadi  18 , Jeffrey A Sparks  19 , Tiffany Y-T Hsu  19 , Naomi J Patel  20 , Emily L Gilbert  21 , Maria O Valenzuela-Almada  7 , Andreas Jönsen  22 , Gianpiero Landolfi  23 , Micaela Fredi  24   25 , Tiphaine Goulenok  26   27 , Mathilde Devaux  28 , Xavier Mariette  29 , Viviane Queyrel  30 , Vasco C Romão  31   32 , Graca Sequeira  33 , Rebecca Hasseli  34 , Bimba Hoyer  35 , Reinhard E Voll  36 , Christof Specker  37 , Roberto Baez  38 , Vanessa Castro-Coello  39 , Hernan Maldonado Ficco  40 , Edgard Torres Reis Neto  41 , Gilda Aparecida Aparecida Ferreira  42   43 , Odirlei Andre André Monticielo  44   45 , Emily Sirotich  46   47 , Jean Liew  48 , Jonathan Hausmann  49   50 , Paul Sufka  51 , Rebecca Grainger  52 , Suleman Bhana  53 , Wendy Costello  54 , Zachary S Wallace  20 , Lindsay Jacobsohn  6 , Tiffany Taylor  6 , Clairissa Ja  6 , Anja Strangfeld  55 , Elsa F Mateus  56   57 , Kimme L Hyrich  58   59 , Loreto Carmona  60 , Saskia Lawson-Tovey  59   61 , Lianne Kearsley-Fleet  62 , Martin Schäfer  63 , Pedro M Machado  64   65   66   67 , Philip C Robinson  68   69 , Milena Gianfrancesco  6 , Jinoos Yazdany  6
Affiliations

Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance

Manuel Francisco Ugarte-Gil et al. Ann Rheum Dis. 2022 Jul.

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 hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised 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 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1-5 mg/day 1.86, 1.20 to 2.66, 6-9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable 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.

Keywords: COVID-19; epidemiology; lupus erythematosus; systemic.

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Conflict of interest statement

Competing interests: MFU-G has received research grants from Pfizer and Janssen, not related to this manuscript. AD-G is supported by the Rheumatology Research Foundation (Scientist Development Award) and the Centers for Disease Control and Prevention. CR-S has received research grants from Janssen, not related to this manuscript. AEC has received consulting fees from AstraZeneca, BMS and GSK, all unrelated to this manuscript. LW has received consulting fees and speaker’s honoraria from Aurinia Pharma unrelated to this manuscript. GJP-E reports no competing interests related to this work. Outside of this work, he reports personal consulting and/or speaking fees from Pfizer, GSK, Janssen and Sanofi (all <US$10 000). MJS has received speaker’s fees from AbbVie, AstraZeneca, Novartis, Pfizer and Roche, all unrelated to this manuscript (all <US10 000). JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253 and P30 AR072577), the Rheumatology Research Foundation (R Bridge Award) and the R. Bruce and Joan M. Mickey Research Scholar Fund. JS has received research support from Bristol-Myers Squibb and performed consultancy for Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum and Pfizer unrelated to this work. NJP has received consulting fees from FVC Health and is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). XM has received consulting’s honorarium from BMS, Galapagos, GSK, Janssen, Novartis, Pfizer, UCB and grants from Ose Pharmaceutical and Pfizer, all unrelated to this manuscript. VQ has no disclosure related to this manuscript. RH was supported by the Justus-Liebig University Giessen (Germany) Clinician Scientist Program in Biomedical Research (JLU-CAREER) to work on the German COVID-19 registry. RH has received consulting/speaker’s fee from Pfizer, Novartis, Amgen, Medac, AbbVie, Gilead, Mylan, TAKEDA/Shire, Roche/Chugai, Bristol-Myers Squibb and Galapagos, all unrelated to this manuscript. REV reports no competing interests related to this work. He has received personal consulting and/or speaking fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Janssen-Cilag, GSK, Hexal, Neutrolis, Novartis, Pfizer (all <US$10 000" and "Pfizer and Roche, all unrelated to this manuscript (all <US$10 000. Institutional research grants were received from Amgen, BMS, Novartis, Pfizer. ETRN has received speaker’s fees from GSK, Novartis, Bracepharma, unrelated to this manuscript. GAAF has received speaker’s fees from Boehringer Ingelheim, unrelated to this manuscript. OAAM has received speaker’s fees from AbbVie, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, UCB and Roche, all unrelated to this manuscript. JL has received research funding from Pfizer outside the submitted work. JH is supported by grants from the Rheumatology Research Foundation and has salary support from the Childhood Arthritis and Rheumatology Research Alliance. He has performed consulting for Novartis, Sobi, Biogen, all unrelated to this work (<US$10 000). PS reports honorarium for doing social media for American College of Rheumatology journals (<US$10 000). RG reports non-financial support from Pfizer Australia, personal fees from Pfizer Australia, personal fees from Cornerstones, personal fees from Janssen New Zealand, non-financial support from Janssen Australia, personal fees from Novartis, outside the submitted work. SB reports non-branded consulting fees for AbbVie, Horizon, and Novartis (all <US$10 000), and is employed by Pfizer. ZSW reports grant support from Bristol-Myers Squibb and Principia/Sanofi and performed consultancy for Viela Bio and MedPace, outside the submitted work. His work is supported by grants from the National Institutes of Health. AS reports grants from a consortium of 13 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis and UCB) supporting the German RABBIT register and personal fees from lectures for AbbVie, MSD, Roche, BMS, Pfizer, outside the submitted work. EFM reports that LPCDR received support for specific activities: grants from AbbVie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work. KLH has received speaker’s honoraria from AbbVie and grant support from Pfizer and BMS, all unrelated to this manuscript. KLH is also supported by the NIHR Manchester BRC. LC has not received fees or personal grants from any laboratory, but her institute works by contract for laboratories among other institutions, such as AbbVie, Gebro Pharma, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, Grünenthal and UCB. All unrelated to this work. PMM has received consulting/speaker’s fees from AbbVie, BMS, Celgene, Galapagos, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript. PCR reports personal fees from AbbVie, Atom Biosciences, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Kukdong, Novartis, UCB, Roche, Pfizer; meeting attendance support from BMS, Pfizer and UCB and grant funding from Janssen, Novartis, Pfizer and UCB Pharma. MG is supported by grants from NIH/NIAM. SJY has received research grants from AstraZeneca, Gilead and BMS, and consulting fees from Aurinia, Pfizer and AstraZeneca. GSA, ZI, SB, SLER, SAE, JY-TH, ELG, MOV-A, AJ, GL, MF, TG, MD, VCR, GS, BH, CS, RB, VC-C, HMF, ES, WC, LJ, TT, CJ, SL-T, LK-F and MS have nothing to disclose.

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