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. 2023 Dec:63:152286.
doi: 10.1016/j.semarthrit.2023.152286. Epub 2023 Oct 29.

Risk factors and outcomes for repeat COVID-19 infection among patients with systemic autoimmune rheumatic diseases: A case-control study

Emily N Kowalski  1 , Xiaosong Wang  1 , Naomi J Patel  2 , Yumeko Kawano  3 , Claire E Cook  4 , Kathleen M M Vanni  1 , Grace Qian  1 , Katarina J Bade  1 , Shruthi Srivatsan  4 , Zachary K Williams  4 , Zachary S Wallace  5 , Jeffrey A Sparks  6
Affiliations

Risk factors and outcomes for repeat COVID-19 infection among patients with systemic autoimmune rheumatic diseases: A case-control study

Emily N Kowalski et al. Semin Arthritis Rheum. 2023 Dec.

Abstract

Objective: To investigate risk factors and outcomes of repeat COVID-19 infections among patients with systemic autoimmune rheumatic diseases (SARDs).

Methods: We performed a case-control study investigating repeat COVID-19 infection within the Mass General Brigham Health Care System. We systematically identified all SARD patients with confirmed COVID-19 (15/Mar/2020 to 17/Oct/2022). Cases had confirmed repeat COVID-19 infections >60 days apart (index date: repeat COVID-19 date). Controls were matched to cases (up to 3:1) by calendar date of first infection and duration between first COVID-19 infection and index dates. We collected demographics, lifestyle, comorbidities, SARD features, and COVID-19 characteristics at initial infection and index date by medical record review. We used conditional logistic regression to identify associations with repeat COVID-19 infection, adjusting for potential confounders. We described the severity of repeat COVID-19 infection among cases.

Results: Among 2203 SARD patients with COVID-19, we identified 76 cases with repeat COVID-19 infection (80.3 % female) and matched to 207 matched controls (77.8 % female) with no repeat infection. At first infection, cases were younger (mean 49.5 vs. 60.3 years, p < 0.0001), less likely to have hypertension (32.9 % vs. 45.9 %, p = 0.050), and less likely to have been hospitalized for COVID-19 (13.2 % vs. 24.6 %, p = 0.037) than controls. At index date, cases were more likely than controls to be rituximab users (18.4 % vs. 6.3 %, p = 0.0021). In the multivariable model, younger age (OR 0.67 per 10 years, 95 %CI 0.54-0.82), rituximab use vs. non-use (OR 3.38, 95 %CI 1.26-9.08), and methotrexate use vs. non-use (OR 2.24, 95 %CI 1.08-4.61) were each associated with repeat COVID-19 infection. Among those with repeat COVID-19 infection, 5/76 (6.6 %) were hospitalized and there were no deaths.

Conclusion: Younger age, rituximab, and methotrexate were each associated with repeat COVID-19 infection risk among patients with SARDs. Reassuringly, there were no deaths, and the hospitalization rate was low among those with repeat COVID-19 infection.

Keywords: COVID-19; Epidemiology; Immunosuppression; Reinfection.

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Conflict of interest statement

Declaration of Competing Interest NJP reports consulting fees from FVC Health, Chronius, and Arrivo Bio unrelated to this work. ZSW reports research support from Bristol Myers Squibb and Principia/Sanofi and consulting/advisory board fees from Viela Bio, Zenas BioPharma, PPD, Visterra, Novartis, BioCryst, Sanofi, Horizon, and MedPace. JAS reports research support from Bristol Myers Squibb and consultancy fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, Pfizer, and ReCor unrelated to this work. All other authors report no competing interests.

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