Factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy: results from the COVID-19 Global Rheumatology Alliance physician-reported registry
Carlo Alberto Scirè,
Laure Gossec,
Loreto Carmona,
Jinoos Yazdany,
Pedro M Machado,
Guillermo J Pons-Estel,
Christophe Richez,
Marie Holmqvist,
Rebecca Grainger,
Jean W Liew,
Emily Sirotich,
Philip C Robinson,
Kristin M D’Silva,
Su-Ann Yeoh,
Milena Gianfrancesco,
Kimme L Hyrich,
Lindsay Jacobsohn,
Saskia Lawson-Tovey,
Elsa F Mateus,
Suleman Bhana,
Jonathan S Hausmann,
Paul Sufka,
Tiffany Y-T Hsu,
Arundathi Jayatilleke,
Martin Schäfer,
Ana Carolina de Oliveira e Silva Montandon,
Paula Jordan,
Samuel Katsuyuki Shinjo,
Zachary Wallace,
Sofía Ornella,
Monique Gore-Massy,
Victor R Pimentel-Quiroz,
Monica Vasquez del Mercado,
Edgard Torres dos Reis Neto,
Laurindo Ferreira da Rocha Junior,
Maria Eugenia D'Angelo Exeni,
Edson Velozo
Affiliations
Carlo Alberto Scirè
8 Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
Laure Gossec
1 INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
Loreto Carmona
44 Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
Jinoos Yazdany
43 Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
Pedro M Machado
1 Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
Guillermo J Pons-Estel
Argentine Society of Rheumatology, Buenos Aires, Argentina
Christophe Richez
Département de Rhumatologie, Referral Center for Rare Systemic Autoimmune Diseases RESO, CHU de Bordeaux, Bordeaux, France
Marie Holmqvist
Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden
Rebecca Grainger
56 Department of Medicine, University of Otago Wellington, Wellington, New Zealand
Jean W Liew
Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
Emily Sirotich
26 Yale School of Medicine, Yale University, New Haven, Connecticut, USA
Philip C Robinson
70 School of Clinical Medicine, University of Queensland, Herston, Queensland, Australia
Kristin M D’Silva
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
Su-Ann Yeoh
Centre for Rheumatology, University College London, London, UK
Milena Gianfrancesco
1 Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
Kimme L Hyrich
NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
Lindsay Jacobsohn
43 Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
Saskia Lawson-Tovey
17 National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
Elsa F Mateus
24 Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
Suleman Bhana
60 Pfizer, Inc, New York, New York, USA
Jonathan S Hausmann
Program in Rheumatology, Boston Children`s Hospital, Boston, MA, USA
Paul Sufka
55 Healthpartners, St. Paul, Minnesota, USA
Tiffany Y-T Hsu
1 Division of Rheumatology, Inflammation, and Immunity, Brigham and Women`s Hospital, Boston, Massachusetts, USA
Arundathi Jayatilleke
Section of Rheumatology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
Martin Schäfer
4 Epidemiology and Health Services Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
Ana Carolina de Oliveira e Silva Montandon
Hospital das Clínicas, Universidade Federal de Goias (UFG), Goiania, Brazil
Paula Jordan
Myositis UK, Southampton, UK
Samuel Katsuyuki Shinjo
Division of Rheumatology, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
Zachary Wallace
3 Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Sofía Ornella
Hospital Interzonal General de Agudos (HIGA) San Martin, La Plata, Buenos Aires, Argentina
Monique Gore-Massy
51 Lupus Foundation of America, Washington, District of Columbia, USA
Victor R Pimentel-Quiroz
Department of Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
Monica Vasquez del Mercado
University of Guadalajara, Guadalajara, Mexico
Edgard Torres dos Reis Neto
Division of Rheumatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
Laurindo Ferreira da Rocha Junior
Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
Maria Eugenia D'Angelo Exeni
Sanatorio Parque, Córdoba, Argentina
Edson Velozo
Sanatorio y Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
Objectives To investigate factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy (IIM).Methods Demographic data, clinical characteristics and COVID-19 outcome severity of adults with IIM were obtained from the COVID-19 Global Rheumatology Alliance physician-reported registry. A 3-point ordinal COVID-19 severity scale was defined: (1) no hospitalisation, (2) hospitalisation (and no death) and (3) death. ORs were estimated using multivariable ordinal logistic regression. Sensitivity analyses were performed using a 4-point ordinal scale: (1) no hospitalisation, (2) hospitalisation with no oxygen (and no death), (3) hospitalisation with oxygen/ventilation (and no death) and 4) death.Results Of 348 patients, 48% were not hospitalised, 39% were hospitalised (and did not die) and 13% died. Older age (OR=1.59/decade, 95% CI 1.31 to 1.91), high disease activity (OR=3.50, 95% CI 1.25 to 9.83; vs remission), ≥2 comorbidities (OR=2.63, 95% CI 1.39 to 4.98; vs none), prednisolone-equivalent dose >7.5 mg/day (OR=2.40, 95% CI 1.09 to 5.28; vs no intake) and exposure to rituximab (OR=2.71, 95% CI 1.28 to 5.72; vs conventional synthetic disease-modifying antirheumatic drugs only) were independently associated with severe COVID-19. In addition to these variables, in the sensitivity analyses, male sex (OR range: 1.65–1.83; vs female) was also significantly associated with severe outcomes, while COVID-19 diagnosis after 1 October 2020 (OR range: 0.51–0.59; vs on/before 15 June 2020) was significantly associated with less severe outcomes, but these associations were not significant in the main model (OR=1.57, 95% CI 0.95 to 2.59; and OR=0.61, 95% CI 0.37 to 1.00; respectively).Conclusions This is the first large registry data on outcomes of COVID-19 in people with IIM. Older age, male sex, higher comorbidity burden, high disease activity, prednisolone-equivalent dose >7.5 mg/day and rituximab exposure were associated with severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with IIM.
