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Observational Study
. 2022;28(24):2022-2028.
doi: 10.2174/1381612828666220614151732.

Prevalence and Death Rate of COVID-19 in Autoimmune Systemic Diseases in the First Three Pandemic Waves. Relationship with Disease Subgroups and Ongoing Therapies

Clodoveo Ferri  1   2 , Vincenzo Raimondo  2 , Laura Gragnani  3 , Dilia Giuggioli  1 , Lorenzo Dagna  4   5 , Antonio Tavoni  6 , Francesco Ursini  6   7 , Massimo L'Andolina  8 , Francesco Caso  9 , Piero Ruscitti  10 , Maurizio Caminiti  11 , Rosario Foti  12 , Valeria Riccieri  13 , Serena Guiducci  14 , Roberta Pellegrini  15 , Elisabetta Zanatta  16 , Giuseppe Varcasia  17 , Domenico Olivo  18 , Pietro Gigliotti  19 , Giovanna Cuomo  20 , Giuseppe Murdaca  21 , Riccardo Cecchetti  22 , Rossella De Angelis  23 , Nicoletta Romeo  24 , Francesca Ingegnoli  25 , Franco Cozzi  26 , Veronica Codullo  27 , Ilaria Cavazzana  28 , Michele Colaci  29 , Giuseppina Abignano  30 , Maria De Santis  31 , Ennio Lubrano  32 , Enrico Fusaro  33 , Amelia Spinella  1 , Federica Lumetti  1 , Giacomo De Luca  4   5 , Silvia Bellando-Randone  14 , Elisa Visalli  12 , Ylenia Dal Bosco  12 , Giorgio Amato  12 , Daiana Giannini  6 , Silvia Bilia  6 , Francesco Masini  20 , Greta Pellegrino  13 , Erika Pigatto  26 , Elena Generali  31 , Giuseppa Pagano Mariano  11 , Giorgio Pettiti  24 , Giovanni Zanframundo  27 , Raffaele Brittelli  2 , Vincenzo Aiello  2 , Rodolfo Caminiti  2 , Daniela Scorpiniti  2 , Tommaso Ferrari  17 , Corrado Campochiaro  4   5 , Veronica Brusi  6 , Micaela Fredi  28 , Liala Moschetti  28 , Fabio Cacciapaglia  34 , Sabrina Rosaria Paparo  35 , Francesca Ragusa  35 , Valeria Mazzi  36 , Giusy Elia  36 , Silvia Martina Ferrari  35 , Ilenia Di Cola  10 , Marta Vadacca  37 , Sebastiano Lorusso  37 , Monica Monti  38 , Serena Lorini  38 , Maria Letizia Aprile  29 , Marco Tasso  9 , Mario Miccoli  35 , Silvia Bosello  39 , Salvatore D'Angelo  30 , Andrea Doria  16 , Franco Franceschini  28 , Riccardo Meliconi  6   7 , Marco Matucci-Cerinic  14 , Florenzo Iannone  34 , Roberto Giacomelli  37 , Carlo Salvarani  1 , Anna Linda Zignego  3 , Poupak Fallahi  40 , Alessandro Antonelli  36
Affiliations
Observational Study

Prevalence and Death Rate of COVID-19 in Autoimmune Systemic Diseases in the First Three Pandemic Waves. Relationship with Disease Subgroups and Ongoing Therapies

Clodoveo Ferri et al. Curr Pharm Des. 2022.

Abstract

Objective: Autoimmune systemic diseases (ASD) represent a predisposing condition to COVID-19. Our prospective, observational multicenter telephone survey study aimed to investigate the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients.

Methods: The study included 3,918 ASD pts (815 M, 3103 F; mean age 59±12SD years) consecutively recruited between March 2020 and May 2021 at the 36 referral centers of COVID-19 and ASD Italian Study Group. The possible development of COVID-19 was recorded by means of a telephone survey using a standardized symptom assessment questionnaire.

Results: ASD patients showed a significantly higher prevalence of COVID-19 (8.37% vs. 6.49%; p<0.0001) but a death rate statistically comparable to the Italian general population (3.65% vs. 2.95%). Among the 328 ASD patients developing COVID-19, 17% needed hospitalization, while mild-moderate manifestations were observed in 83% of cases. Moreover, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular events; systemic sclerosis (SSc) patients showed a significantly higher COVID-19-related death rate compared to the general population (6.29% vs. 2.95%; p=0.018). Major adverse prognostic factors to develop COVID-19 were: older age, male gender, SSc, pre-existing ASD-related interstitial lung involvement, and long-term steroid treatment. Of note, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs. 46.99%; p=0.000), as well as the SSc patients treated with low dose aspirin (with 5.57% vs. without 27.84%; p=0.000).

Conclusion: During the first three pandemic waves, ASD patients showed a death rate comparable to the general population despite the significantly higher prevalence of COVID-19. A significantly increased COVID-19- related mortality was recorded in only SSc patients' subgroup, possibly favored by preexisting lung fibrosis. Moreover, ongoing long-term treatment with csDMARDs in ASD might usefully contribute to the generally positive outcomes of this frail patients' population.

Keywords: COVID-19; DMARD; aspirin; autoimmune systemic diseases; interstitial lung involvement; steroids; systemic sclerosis; vasculitis.

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