RMD Open (Apr 2021)

High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry

  • Valderílio Feijó Azevedo,
  • Sueli Carneiro,
  • Francinne Machado Ribeiro,
  • Ana Karla G Melo,
  • Ricardo Xavier,
  • Claudia Diniz Lopes Marques,
  • Adriana Maria Kakehasi,
  • Marcelo Medeiros Pinheiro,
  • Licia Maria Henrique Mota,
  • Cleandro Pires Albuquerque,
  • Carolina Rocha Silva,
  • Gabriela Porfirio Jardim Santos,
  • Edgard Torres Reis-Neto,
  • Pedro Matos,
  • Guilherme Devide,
  • Andrea Dantas,
  • Rina Dalva Giorgi,
  • Adriana de Oliveira Marinho,
  • Lilian David Azevedo Valadares,
  • Gilda Aparecida Ferreira,
  • Flavia Patricia de Sena Santos,
  • Sandra Lucia Euzebio Ribeiro,
  • Nicole Pamplona Bueno Andrade,
  • Michel Alexandre Yazbek,
  • Viviane Angelina de Souza,
  • Eduardo S Paiva,
  • Ana Beatriz Santos Bacchiega de Freitas,
  • José Roberto Provenza,
  • Ricardo Acayaba de Toledo,
  • Sheilla Fontenelle,
  • Gecilmara Cristina Salviato Pileggi,
  • Ana Paula Monteiro Gomides Reis,
  • Felipe Omura

DOI
https://doi.org/10.1136/rmdopen-2020-001461
Journal volume & issue
Vol. 7, no. 1

Abstract

Read online

Objectives To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19.Methods Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study.Results 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018).Conclusions Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.