Impact of Risk Factors on <scp>COVID</scp>‐19 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the <scp>COVID</scp>‐19 Global Rheumatology Alliance Registry-Reference-Cited by-同舟云学术

Impact of Risk Factors on COVID‐19 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the COVID‐19 Global Rheumatology Alliance Registry

Published:2023-11-07 Issue: Volume: Page:
ISSN:2151-464X
Container-title:Arthritis Care & Research
language:en
Short-container-title:Arthritis Care & Research

Author:

Yazdany Jinoos¹^ORCID,Ware Anna²^ORCID,Wallace Zachary S.³^ORCID,Bhana Suleman⁴,Grainger Rebecca⁵^ORCID,Hachulla Eric⁶^ORCID,Richez Christophe⁷^ORCID,Cacoub Patrice⁸^ORCID,Hausmann Jonathan S.⁹^ORCID,Liew Jean W.¹⁰,Sirotich Emily¹¹,Jacobsohn Lindsay¹,Strangfeld Anja¹²,Mateus Elsa F.¹³,Hyrich Kimme L.¹⁴^ORCID,Gossec Laure¹⁵^ORCID,Carmona Loreto¹⁶,Lawson‐Tovey Saskia¹⁷^ORCID,Kearsley‐Fleet Lianne¹⁸^ORCID,Schaefer Martin¹⁹^ORCID,Ribeiro Sandra Lucia Euzebio²⁰^ORCID,Al‐Emadi Samar²¹^ORCID,Hasseli Rebecca²²^ORCID,Müller‐Ladner Ulf²³,Specker Christof²⁴^ORCID,Schulze‐Koops Hendrik²⁵^ORCID,Bernardes Miguel²⁶^ORCID,Fraga Vanessa Machado²⁷^ORCID,Rodrigues Ana Maria²⁸^ORCID,Sparks Jeffrey A.²⁹^ORCID,Ljung Lotta³⁰^ORCID,Di Giuseppe Daniela³¹^ORCID,Tidblad Liselotte³¹^ORCID,Wise Leanna³²^ORCID,Duarte‐García Alí³³^ORCID,Ugarte‐Gil Manuel F.³⁴^ORCID,Colunga‐Pedraza Iris Jazmín³⁵^ORCID,Martínez‐Martínez Marco Ulises³⁶^ORCID,Alpizar‐Rodriguez Deshire³⁷^ORCID,Xavier Ricardo Machado³⁸,Isnardi Carolina A.³⁹^ORCID,Pera Mariana⁴⁰^ORCID,Pons‐Estel Guillermo⁴¹^ORCID,Izadi Zara¹,Gianfrancesco Milena A.¹^ORCID,Carrara Greta⁴²^ORCID,Scirè Carlo Alberto⁴³^ORCID,Zanetti Anna⁴²^ORCID,Machado Pedro M.⁴⁴^ORCID

Affiliation:

1. University of California San Francisco

2. National Center for Collaborative Healthcare Innovation, Palo Alto Department of Veterans Affairs Healthcare System Palo Alto California

3. Massachusetts General Hospital and Harvard Medical School Boston

4. Pfizer New York City New York

5. University of Otago Wellington and Te Whatu Ora, Health New Zealand Capital, Coast and Hutt Valley Wellington New Zealand

6. Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire (CHU) de Lille, pour la Filière des maladies Auto‐Immunes et Autoinflammatoires Rares Lille France

7. Service de Rhumatologie, Centre de référence des maladies autoimmunes systémiques rares de l'Est et du Sud‐Ouest de France, CHU de Bordeaux, pour la Société Française de Rhumatologie Bordeaux France

8. AP‐HP, Groupe Hospitalier Pitié‐Salpêtrière, Société Nationale Française de Médecine Interne Paris France

9. Boston Children's Hospital and Harvard Medical School Boston Massachusetts

10. Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts

11. Yale School of Medicine New Haven Connecticut

12. German Rheumatism Research Center and Charité University Hospital Berlin Germany

13. Portuguese League Against Rheumatic Diseases, Lisbon, Portugal, and European Alliance of Associations for Rheumatology Kilchberg Switzerland

14. Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester UK

15. Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP‐HP, Pitié‐Salpêtrière hospital Paris France

16. Instituto de Salud Musculoesquelética Madrid Spain

17. Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester UK

18. Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre Manchester UK

19. German Rheumatism Research Center Berlin Germany

20. Federal University of Amazonas Manaus Brazil

21. Hamad General Hospital Doha Qatar

22. University Hospital Munster, Munster, Germany, and Justus Liebig University Giessen Kerckhoff Germany

23. Justus Liebig University Giessen Kerckhoff Germany

24. Kliniken Essen‐Mitte Essen Germany

25. University of Munich Munich Germany

26. University of Porto and Centro Hospitalar e Universitário de São João Porto Portugal

27. Hospital Garcia de Orta Almada Portugal

28. Sociedade Portuguesa de Reumatologia and Comprehensive Health Research Centre, Nova Medical School, Universidade Nova de Lisboa Lisbon Portugal

29. Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts

30. Karolinska Institutet and Academic Specialist Centre, Stockholm Health Care Services, Region Stockholm Stockholm Sweden

31. Karolinska Institutet Stockholm Sweden

32. Keck School of Medicine, University of Southern California Los Angeles

33. Mayo Clinic Rochester Minnesota

34. Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémica, Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen ‐ EsSalud Lima Peru

35. Hospital Universitario José Eleuterio González Monterrey Mexico

36. Hospital General de Subzona No. 9, Instituto Mexicano del Seguro Social San Luis, Potosí Mexico

37. Colegio Mexicano de Reumatología Mexico City Mexico

38. Universidade Federal do Rio Grande do Sul, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre Porto Alegre Brazil

39. Argentine Society of Rheumatology Buenos Aires Argentina

40. Hospital Angel C. Padilla, San Miguel de Tucuman Tucuman Argentina

41. Universidad Nacional de Rosario, Rosario, Argentina, and College of Physicians of the Province of Santa Fe 2nd Santa Fe Argentina

42. Italian Society for Rheumatology Milan Italy

43. Italian Society for Rheumatology and School of Medicine, University of Milano‐Bicocca Milan Italy

44. University College London, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, and Northwick Park Hospital, London North West University Healthcare NHS Trust London UK

Abstract

ObjectiveApproximately one third of individuals worldwide have not received a COVID‐19 vaccine. Although studies have investigated risk factors linked to severe COVID‐19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID‐19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern.MethodsPatients with RDs and COVID‐19 were entered into the COVID‐19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID‐19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates. The main analysis included all unvaccinated patients across COVID‐19 pandemic epochs; subanalyses stratified patients according to RD types.ResultsAmong 19,256 unvaccinated people with RDs and COVID‐19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B‐cell–depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B‐cell–depleting therapy was associated with worse outcomes.ConclusionRisk factors for severe COVID‐19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID‐19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study.

Funder

American College of Rheumatology Research and Education Foundation

European League Against Rheumatism

Publisher

Wiley

Subject

Rheumatology

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