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Wu Y, Li Y, Zhou Y, Bai X, Liu Y. Bioinformatics and systems-biology approach to identify common pathogenic mechanisms for COVID-19 and systemic lupus erythematosus. Autoimmunity 2024; 57:2304826. [PMID: 38332666 DOI: 10.1080/08916934.2024.2304826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has brought a heavy burden to the world, interestingly, it shares many clinical symptoms with systemic lupus erythematosus (SLE). It is unclear whether there is a similar pathological process between COVID-9 and SLE. In addition, we don't know how to treat SLE patients with COVID-19. In this study, we analyse the potential similar pathogenesis between SLE and COVID-19 and explore their possible drug regimens using bioinformatics and systems biology approaches. METHODS The common differentially expressed genes (DEGs) were extracted from the COVID-19 datasets and the SLE datasets for functional enrichment, pathway analysis and candidate drug analysis. RESULT Based on the two transcriptome datasets between COVID-19 and SLE, 325 common DEGs were selected. Hub genes were identified by protein-protein interaction (PPI) analysis. few found a variety of similar functional changes between COVID-19 and SLE, which may be related to the pathogenesis of COVID-19. Besides, we explored the related regulatory networks. Then, through drug target matching, we found many candidate drugs for patients with COVID-19 only or COVID-19 combined with SLE. CONCLUSION COVID-19 and SLE patients share many common hub genes, related pathways and regulatory networks. Based on these common targets, we found many potential drugs that could be used in treating patient with COVID-19 or COVID-19 combined with SLE.
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Affiliation(s)
- Yinlan Wu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yanhong Li
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhou
- Department of Respiratory and Critical Care Medicine, Chengdu First People's Hospital, Chengdu, China
| | - Xiufeng Bai
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Human Disease and Immunotherapies, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Grosso D, Wagner JL, O'Connor A, Keck K, Huang Y, Wang ZX, Mehler H, Leiby B, Flomenberg P, Gergis U, Nikbakht N, Morris M, Karp J, Peedin A, Flomenberg N. Safety and feasibility of third-party cytotoxic T lymphocytes for high-risk patients with COVID-19. Blood Adv 2024; 8:4113-4124. [PMID: 38885482 DOI: 10.1182/bloodadvances.2024013344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/24/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
ABSTRACT Cytotoxic T lymphocytes (CTLs) destroy virally infected cells and are critical for the elimination of viral infections such as those caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Delayed and dysfunctional adaptive immune responses to SARS-CoV-2 are associated with poor outcomes. Treatment with allogeneic SARS-CoV-2-specific CTLs may enhance cellular immunity in high-risk patients providing a safe, direct mechanism of treatment. Thirty high-risk ambulatory patients with COVID-19 were enrolled in a phase 1 trial assessing the safety of third party, SARS-CoV-2-specific CTLs. Twelve interventional patients, 6 of whom were immunocompromised, matched the HLA-A∗02:01 restriction of the CTLs and received a single infusion of 1 of 4 escalating doses of a product containing 68.5% SARS-CoV-2-specific CD8+ CTLs/total cells. Symptom improvement and resolution in these patients was compared with an observational group of 18 patients lacking HLA-A∗02:01 who could receive standard of care. No dose-limiting toxicities were observed at any dosing level. Nasal swab polymerase chain reaction testing showed ≥88% and >99% viral elimination from baseline in all patients at 4 and 14 days after infusion, respectively. The CTLs did not interfere with the development of endogenous anti-SARS-CoV-2 humoral or cellular responses. T-cell receptor β analysis showed persistence of donor-derived SARS-CoV-2-specific CTLs through the end of the 6-month follow-up period. Interventional patients consistently reported symptomatic improvement 2 to 3 days after infusion, whereas improvement was more variable in observational patients. SARS-CoV-2-specific CTLs are a potentially feasible cellular therapy for COVID-19 illness. This trial was registered at www.clinicaltrials.gov as #NCT04765449.
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Affiliation(s)
- Dolores Grosso
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - John L Wagner
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Allyson O'Connor
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Kaitlyn Keck
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Yanping Huang
- Department of Pathology and Genomic Medicine, Histocompatibility and Immunogenetics Laboratory, Thomas Jefferson University, Philadelphia, PA
| | - Zi-Xuan Wang
- Departments of Surgery and Pathology, Molecular and Genomic Pathology Laboratory, Thomas Jefferson University, Philadelphia, PA
| | - Hilary Mehler
- Department of Pathology and Genomic Medicine, Histocompatibility and Immunogenetics Laboratory, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Phyllis Flomenberg
- Division of Infectious Diseases, Department of Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Usama Gergis
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Cutaneous Lymphoma Clinic, Thomas Jefferson University, Philadelphia, PA
| | - Michael Morris
- Department of Emergency Medicine, Thomas Jefferson University Washington Township Hospital, Sewell, NJ
| | - Julie Karp
- Department of Pathology and Genomic Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Alexis Peedin
- Department of Pathology and Genomic Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Neal Flomenberg
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Wu Y, Li Y, Wu T, Huang D, Wu J, Zhang W, Jiang X, Yao C, Liang X, Cheng L, Liao Z, Xu F, Tan C, Liu Y, Herrmann M. COVID-19 in Systemic Lupus Erythematosus patients treated with belimumab: a retrospective clinical study. Immunol Res 2024; 72:418-429. [PMID: 38133855 DOI: 10.1007/s12026-023-09449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Routine use of immunosuppressive agents in systemic lupus erythematosus (SLE) patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) potentially increases the risk of adverse outcomes. belimumab, a monoclonal antibody for the treatment of SLE, remains untested for its specific impact on coronavirus disease 2019 (COVID-19) symptoms in these patients. Here, this research investigated the effect of belimumab on COVID-19 symptoms in SLE patients infected with SARS-CoV-2. METHODS This study enrolled SLE patients who underwent treatment with belimumab. After thorough screening based on the inclusion and exclusion criteria, data pertaining to COVID-19 for both the participants and their cohabitants were obtained through telephone follow-up. The potential impact of belimumab on COVID-19 was evaluated by comparing COVID-19 symptoms and medication use across various groups to investigate the association between belimumab treatment and COVID-19 in SLE. RESULTS This study involved 123 SLE patients, of whom 89.4% tested positive for SARS-CoV-2. Among cohabitants of SLE patients, the SARS-CoV-2 positive rate was 87.2% (p = 0.543). Patients treated with belimumab exhibited a lower incidence of multiple COVID-19 symptoms than their cohabitating counterparts (p < 0.001). This protective effect was found to be partially related to the time of last belimumab administration. Among those with COVID-19, 30 patients opted to discontinue their anti-SLE drugs, and among them, 53% chose to discontinue belimumab. Discontinuing drugs did not increase the risk of hospitalization due to SARS-CoV-2 infection. CONCLUSION This study concluded that treatment with belimumab did not increase susceptibility to COVID-19 and beneficially alleviated the symptoms of COVID-19.
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Affiliation(s)
- Yinlan Wu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Yanhong Li
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Tong Wu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Deying Huang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | | | | | | | | | - Xiuping Liang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Lu Cheng
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China
| | - Zehui Liao
- Meishan People's Hospital, Meishan, China
| | - Fang Xu
- Meishan People's Hospital, Meishan, China
| | - Chunyu Tan
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China.
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China.
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China.
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China.
- Institute of Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, China.
| | - Martin Herrmann
- Department of Medicine 3, Universitäts-klinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie DZI, Universitätsklinikum Erlangen, Erlangen, Germany
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Hasseli R, Regierer AC, Strangfeld A, Pfeil A. [The German COVID-19 rheumatism register]. Z Rheumatol 2024:10.1007/s00393-024-01516-9. [PMID: 38816582 DOI: 10.1007/s00393-024-01516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 06/01/2024]
Abstract
At the beginning of the coronavirus disease 2019 (COVID-19) pandemic in December 2019 there was no available evidence regarding the management of immunosuppressive or immunomodulatory treatment and the potential outcomes of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections in inflammatory rheumatic diseases (IRD). As a result, the Justus Liebig University of Giessen, Germany, in collaboration with the German Society for Rheumatology, established the German COVID-19 register ( www.covid19-rheuma.de ). The COVID-19 register enabled for the first time a systematic documentation and evaluation of viral infections in patients with IRD. The data collection started as early as March 2020. Currently, the register is one of the largest global registers in the field of COVID-19 and IRD. As of 18 December 2023 the register has recorded more than 7100 cases. The first scientific findings on SARS-CoV‑2 infections in IRD patients were generated from the register in 2020, showing an association between disease activity of IRD, certain comorbidities, such as cardiovascular diseases and treatment with rituximab, with an unfavorable course. The contents and construction of the database of the register were designed at the conception to allow collaboration and data exchange with other national and international registers (e.g., EULAR COVID-19 register, COVID-19 global rheumatology alliance and the Lean European open survey on SARS-CoV‑2 infected patients). In addition, other registers and surveys were initiated. A vaccination register documents the tolerability and possible adverse reactions to COVID-19 vaccination in IRD patients. The data resulted in numerous publications and formed the basis for national and international recommendations for action in the care and vaccination of IRD patients during the COVID-19 pandemic. In summary, the German COVID-19 register has made a significant contribution to the understanding of the course of COVID-19 in IRD patients and has facilitated international collaboration for a better understanding of COVID-19 and IRD.
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Affiliation(s)
- Rebecca Hasseli
- Medizinische Klinik D, Sektion für Rheumatologie und Klinische Immunologie, Abteilung für Translationale Rheumatologie und Immunologie, Institut für Muskuloskelettale Medizin (IMM), Universitätsklinikum Münster, Münster, Deutschland.
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Deutschland.
| | - Anne C Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum, Berlin, Deutschland
| | - Anja Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum, Berlin, Deutschland
| | - Alexander Pfeil
- Funktionsbereich Rheumatologie und Osteologie, Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
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Lupu VV, Lupu A, Jechel E, Starcea IM, Stoleriu G, Ioniuc I, Azoicai A, Danielescu C, Knieling A, Borka-Balas R, Salaru DL, Revenco N, Fotea S. The role of vitamin D in pediatric systemic lupus erythematosus - a double pawn in the immune and microbial balance. Front Immunol 2024; 15:1373904. [PMID: 38715605 PMCID: PMC11074404 DOI: 10.3389/fimmu.2024.1373904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/08/2024] [Indexed: 05/23/2024] Open
Abstract
Having increased popularity during the Covid-19 pandemic, vitamin D3 is currently impressing thanks to the numerous researches aimed at its interactions with the body's homeostasis. At the same time, there is a peak in terms of recommendations for supplementation with it. Some of the studies focus on the link between autoimmune diseases and nutritional deficiencies, especially vitamin D3. Since the specialized literature aimed at children (patients between 0-18 years old) is far from equal to the informational diversity of the adult-centered branch, this review aims to bring up to date the relationship between the microbial and nutritional balance and the activity of pediatric systemic lupus erythematosus (pSLE). The desired practical purpose resides in a better understanding and an adequate, individualized management of the affected persons to reduce morbidity. The center of the summary is to establish the impact of hypovitaminosis D in the development and evolution of pediatric lupus erythematosus. We will address aspects related to the two entities of the impact played by vitamin D3 in the pathophysiological cascade of lupus, but also the risk of toxicity and its effects when the deficiency is over supplemented (hypervitaminosis D). We will debate the relationship of hypovitaminosis D with the modulation of immune function, the potentiation of inflammatory processes, the increase of oxidative stress, the perfusion of cognitive brain areas, the seasonal incidence of SLE and its severity. Finally, we review current knowledge, post-pandemic, regarding the hypovitaminosis D - pSLE relationship.
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Affiliation(s)
- Vasile Valeriu Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ancuta Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Elena Jechel
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | | | - Gabriela Stoleriu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galati, Romania
| | - Ileana Ioniuc
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Alice Azoicai
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ciprian Danielescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Anton Knieling
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Reka Borka-Balas
- Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Delia Lidia Salaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ninel Revenco
- Pediatrics, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Silvia Fotea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galati, Romania
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Liu PC, Zhang M, Li JB, Peng YL, Yu SJ, Wu R. Factors affecting different COVID-19 outcomes in patients with systemic lupus erythematosus during the second pandemic wave of COVID-19 in China. Lupus 2024; 33:357-364. [PMID: 38314781 DOI: 10.1177/09612033241230736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To investigate characteristics associated with different COVID-19 outcomes of people with systemic lupus erythematosus (SLE) and COVID-19 during the second pandemic wave of COVID-19 in China. METHODS In this retrospective study, people with SLE and COVID-19 who visited the First Affiliated Hospital of Nanchang University from December 2022 and February 2023 were subjected to this study. The three possible outcomes were listed in order of ordinal severity: (1) not hospitalized, (2) hospitalized but not receiving oxygenation, and (3) hospitalized with any ventilation or oxygenation. A multivariable ordinal logistic regression model was built to examine the association between COVID-19 severity and demographic traits, medications, comorbidities, and disease activity. Furthermore, among the 301 SLE patients included in our study, only two patients experienced mortality. In order to maintain statistical rigor, we have included these two deceased patients in the outcome measure of hospitalized with any ventilation or oxygenation. RESULTS A total of 301 patients with SLE were enrolled in this study. The multivariate ordinal logistic regression analyses indicated that high SLE disease activity (vs remission; OR 39.04, 95% CI 3.08 to 494.44, p = .005) was associated with more severe outcomes. Three doses of COVID-19 vaccination (OR 0.19, 95% CI 0.07 to 0.51, p = .001), glucocorticoids dose (1-5 mg/day 0.14, 0.03 to 0.73, p = .020, and 6-9 mg/day 0.12, 0.02 to 0.61, p = .010), and more intensive immunosuppression drugs (0.34, 0.12 to 0.97, p = .044) were associated with better outcomes. In age-adjusted and sex-adjusted models, telitacicept (6.66, 1.35 to 32.86, p = .020) and rituximab (7.81, 1.87 to 32.66, p = .005) were associated with more severe outcomes. Hydroxychloroquine (0.47, 0.25 to 0.88, p = .018) was associated with favorable outcomes. CONCLUSION Different COVID-19 outcomes in people with SLE are mostly driven by COVID-19 vaccination, medications, and activity SLE. More importantly, three doses of COVID-19 vaccination may be associated with better outcomes.
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Affiliation(s)
- Peng-Cheng Liu
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Min Zhang
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jian-Bin Li
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yi-Lin Peng
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Shu-Jiao Yu
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Rui Wu
- Department of Rheumatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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Kashiwado Y, Kimoto Y, Oku K, Yamamoto M, Ohshima S, Ito S, Horiuchi T, Takeuchi T. Prognostic improvement and treatment of COVID-19 in patients with rheumatic diseases until December 2022: Analysis of the JCR COVID-19 registry in Japan. Mod Rheumatol 2024; 34:576-583. [PMID: 37338284 DOI: 10.1093/mr/road057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES The aim is to evaluate the treatment and prognosis of coronavirus disease 2019 (COVID-19) according to the time of onset and dominant strain in patients with rheumatic diseases. METHODS This study analysed a nationwide COVID-19 registry of Japanese patients with rheumatic diseases compiled between June 2020 and December 2022. The primary endpoints of the study were hypoxaemia incidence and mortality. Multivariate logistic regression analysis was performed to assess differences according to the period of onset. RESULTS A total of 760 patients were compared across four periods. Hypoxaemia rates were 34.9, 27.2, 13.8, and 6.1% and mortality rates were 5.6, 3.5, 1.8, and 0% until June 2021, between July and December 2021, January and June 2022, and July and December 2022, respectively. History of vaccination (odds ratio, 0.39; 95% confidence interval, 0.18-0.84) and onset during the July to December 2022 Omicron BA.5-dominant period (odds ratio, 0.17; 95% confidence interval, 0.07-0.41) were negatively associated with hypoxaemia in the multivariate model, adjusting for age, sex, obesity, glucocorticoid dose, and comorbidities. Over the Omicron-dominant period, antiviral treatment was administered in 30.5% of patients with a low probability of hypoxaemia. CONCLUSIONS COVID-19 prognosis improved over time in patients with rheumatic diseases, especially in the Omicron BA.5-dominant period. In the future, treatment of mild cases should be optimised.
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Affiliation(s)
- Yusuke Kashiwado
- Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan
| | - Yasutaka Kimoto
- Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan
| | - Kenji Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mari Yamamoto
- Department of Rheumatology and Nephrology, Chubu Rosai Hospital, Aichi, Japan
| | - Shiro Ohshima
- Department of Clinical Research, Rheumatology and Allergology, Osaka Minami Medical Center, Osaka, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
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8
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Akhlaq A, Aamer S, Hasan KM, Muzammil TS, Sohail AH, Quazi MA, Khan MS, Sheikh AB. Systemic lupus erythematosus is associated with increased risk of mortality and acute kidney injury in patients with COVID-19 hospitalization: Insights from a National Inpatient Sample analysis. Lupus 2024; 33:248-254. [PMID: 38194931 DOI: 10.1177/09612033241227027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has significantly impacted global health, especially for patients with chronic diseases that may compromise the immune system. This study investigates the association between systemic lupus erythematosus (SLE) and COVID-19 outcomes. METHODS Data from the National Inpatient Sample (NIS) were analyzed to create a retrospective cohort of COVID-19 hospitalizations, comparing patients with and without SLE. Propensity-score matched analysis was conducted to assess the association between SLE and clinical outcomes in COVID-19 hospitalizations. RESULTS The study included over a million COVID-19 hospitalizations, with approximately 0.5% having a secondary diagnosis of SLE. The SLE-COVID hospitalizations were predominantly female and younger, with a median age of 57.2, while the non-SLE-COVID group had a median age of 64.8 years. Comorbidities such as chronic obstructive pulmonary disease, renal failure, liver disease, and others were more prevalent in the SLE-COVID group. Patients with SLE and COVID-19 had a significantly higher incidence of acute kidney injury requiring dialysis than those without SLE. In-hospital mortality was higher in the SLE group, particularly in the 18-44 year age group (6.15% vs 2.47%, p = .022). CONCLUSION COVID-19 patients with SLE are at an increased mortality risk, especially in the younger age group, and a higher incidence of acute kidney injury requiring dialysis. The elevated risk of adverse outcomes underscores the vulnerability of SLE patients to COVID-19. These findings emphasize the importance of special precautions and patient education for individuals with SLE to mitigate the risks associated with COVID-19.
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Affiliation(s)
- Anum Akhlaq
- Department of Medicine, University of Mississippi University Hospital, Jackson, MS, USA
| | - Sameen Aamer
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | | | | | | | - Mohammed A Quazi
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Muhammad Salman Khan
- Department of Radiology, University of Texas at Houston Health Sciences Center, Houston, TX, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Zavala-Flores E, Salcedo-Matienzo J, Huamanchumo-Guzman R, Berrocal-Kasay A, Alarcón GS. A 12-month follow-up study of patients with systemic lupus erythematosus after immunization against SARS-CoV-2. Lupus 2024; 33:282-288. [PMID: 38237938 DOI: 10.1177/09612033241227811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To identify all post-BNT162b2 vaccination (BioNTech and Pfizer) events during the ensuing 12 months in patients with systemic lupus erythematosus (SLE) from the Immuno-Rheumatology Department at Cayetano Heredia Hospital's cohort, Lima, Perú. METHODS A 12-month follow-up study was conducted from the first dose of immunization with the BNT162b2 vaccine, which was given between May and June 2021, to SLE patients from this cohort. RESULTS The initial population was constituted by 100 patients (100 patients received the 1st dose, 90 the 2nd dose, and 85 the 3rd dose of this vaccine); 33 patients presented a SLE reactivation (flare), 9% (9/100) post 1st dose, 26.6% (24/90) post 2nd dose, and 16.4% (14/85) post 3rd dose. The most common types of flare were articular (26) and renal (14) with 5/33 (15.1%) requiring hospitalization for flare management. A negative association with flare occurrence was found between the use of hydroxychloroquine RR 0.43 (0.21-0.85) and the opposite was the case for azathioprine RR 2.70 (1.39-5.25). During follow-up, 26 patients developed SARS-CoV-2 infection of whom three required hospitalization, one of whom died. CONCLUSIONS 33 of 100 SLE patients immunized with BNT162b2 vaccine against SARS-CoV-2, presented SLE flares (47 episodes in total); 5 of these patients required in-hospital management and all fully recovered; 26 patients had SARS-CoV-2 infection; three required hospitalization, one died.
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Affiliation(s)
- Ernesto Zavala-Flores
- Department of Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Immuno-Rheumatology, Cayetano Heredia Hospital, Lima, Peru
- Cayetano Heredia Peruvian University, Lima, Peru
| | - Jannin Salcedo-Matienzo
- Department of Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Clinical Immunology and Rheumatology, The University of Alabama Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Roberto Huamanchumo-Guzman
- Department of Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Immuno-Rheumatology, Cayetano Heredia Hospital, Lima, Peru
- Cayetano Heredia Peruvian University, Lima, Peru
| | - Alfredo Berrocal-Kasay
- Department of Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Immuno-Rheumatology, Cayetano Heredia Hospital, Lima, Peru
- Cayetano Heredia Peruvian University, Lima, Peru
| | - Graciela S Alarcón
- Department of Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Clinical Immunology and Rheumatology, The University of Alabama Marnix E. Heersink School of Medicine, Birmingham, AL, USA
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10
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Zhao X, Wu H, Li S, Gao C, Wang J, Ge L, Song Z, Ni B, You Y. The impact of the COVID-19 pandemic on SLE. Mod Rheumatol 2024; 34:247-264. [PMID: 36961736 DOI: 10.1093/mr/road030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/21/2023] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
Little is known about the association between coronavirus disease 2019 (COVID-19) and autoimmune diseases, especially in the case of systemic lupus erythematosus (SLE). SLE patients met with many questions during the pandemic in COVID-19, such as how to minimize risk of infection, the complex pathological features and cytokine profiles, diagnosis and treatment, rational choice of drugs and vaccine, good nursing, psychological supervision, and so on. In this study, we review and discuss the multifaceted effects of the COVID-19 pandemic on patients living with SLE using the available literature. Cross-talk in implicated inflammatory pathways/mechanisms exists between SLE and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and SARS-CoV-2 displays similar clinical characteristics and immuno-inflammatory responses to SLE. Current epidemiological data inadequately assess the risk and severity of COVID-19 infection in patients with SLE. More evidence has shown that hydroxychloroquine and chloroquine cannot prevent COVID-19. During the pandemic, patients with SLE had a higher rate of hospitalization. Vaccination helps to reduce the risk of infection. Several therapies for patients with SLE infected with COVID-19 are discussed. The cases in the study can provide meaningful information for clinical diagnosis and management. Our main aim is to help preventing infection and highlight treatment options for patients with SLE infected with COVID-19.
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Affiliation(s)
- Xingwang Zhao
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Haohao Wu
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shifei Li
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Cuie Gao
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Juan Wang
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lan Ge
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhiqiang Song
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Bing Ni
- Department of Pathophysiology, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yi You
- Department of Dermatology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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11
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Gonzales JRM, Salido EO, Barte JHA. Healthcare Encounters and Outcomes of Filipino Patients with Systemic Lupus Erythematosus Managed at a Tertiary COVID-19 Referral Center. ACTA MEDICA PHILIPPINA 2024; 58:27-35. [PMID: 38966156 PMCID: PMC11219517 DOI: 10.47895/amp.vi0.5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has limited healthcare delivery for patients with chronic diseases, including Systemic Lupus Erythematosus (SLE). This study aims to describe the outcomes of patients with SLE in a national COVID-19 referral center in the Philippines. Methods A review of records of all adult patients with SLE seen in the University of the Philippines-Philippine General Hospital (UP-PGH) from March 2020 to December 2021 was done. Data about patient characteristics, health encounters, and outcomes before and after the first visit during the study period were extracted. Descriptive statistics were employed. Results Our population of 403 patients was predominantly young (mean age 34.53 ± 11.14 years), female, and unemployed. This consisted of 370 known cases of SLE, 92 were diagnosed in institutions outside UP-PGH, and 33 new patients. Over the 22-month study period, there were 2,093 medical encounters, most of which were teleconsultations (81.70%). During an average gap of 53.6 ± 26.7 weeks between the last consultation and the first visit within the pandemic study period, 84 patients (22.70%) discontinued at least one of their SLE control medications, 68 (18.38%) patients developed a lupus flare, and 79 (21.35%) were hospitalized for various reasons. On their return to the rheumatology clinic during the pandemic, 37.47% were in lupus flare, 28.29% needed to be hospitalized, and 20 died. However, 86.75% of flares were controlled. During subsequent health encounters, 48 patients had a new flare (43 of these were controlled) and 20 died. The most common reason for hospitalization (n=160) was lupus disease flare and the most common cause of death (n=40) was pneumonia. Sixty patients acquired COVID-19 infection from which most recovered and four died. Conclusion Audio teleconsultation was the most common method used by our lupus cohort to interact with their doctors during the pandemic. There was an average of a year-long interruption in medical care for 62.70%. More than a third developed a disease flare and 15% acquired COVID-19 but outcomes were good in more than 85%. Despite the challenges posed by the pandemic, the majority of our lupus cohort who were able to continue their treatment had favorable outcomes.
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Affiliation(s)
| | | | - James Harold A. Barte
- Division of Rheumatology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
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12
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Hong X, Wang X, Dai N, Sun Y, Liu H, Cheng X, Ye J, Shi H, Hu Q, Meng J, Zhou Z, Yang C, Teng J, Su Y, Chi H. Characteristics of COVID-19 and Impact of Disease Activity in Patients with Adult-Onset Still's Disease. Rheumatol Ther 2024; 11:201-212. [PMID: 38183598 PMCID: PMC10796879 DOI: 10.1007/s40744-023-00632-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION This study aimed to characterize the morbidity, hospitalization, and mortality rates among patients with adult-onset Still's disease (AOSD) affected by coronavirus disease 2019 (COVID-19) and explore the impact of COVID-19 on the disease activity of AOSD. METHODS Data on the clinical and demographic characteristics, COVID-19-related symptoms, and outcomes were retrospectively collected. Patients were stratified according to COVID-19 severity and associations between risk factors and outcomes were analyzed using multivariate logistic regression. The disease activity of patients with AOSD flares after COVID-19 was described. RESULTS A total of 188 patients with AOSD were followed up, of whom 75.5% (n = 142) had a confirmed or highly suspected COVID-19. Patients on medium or high-dose oral glucocorticoids or Janus kinase (JAK) inhibitors were at increased risk of developing moderate to severe COVID-19. Six patients suffered flares of AOSD following COVID-19 in a short period; however, the relapse rate was not statistically increased compared with patients without COVID-19. CONCLUSION Patients with AOSD receiving medium or high-dose glucocorticoid therapy or JAK inhibitors had worse COVID-19 outcomes. Further work is needed to explore risk factors affecting COVID-19 outcomes and the impact of COVID-19 on disease activity in AOSD.
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Affiliation(s)
- Xinyue Hong
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Xiaoming Wang
- Department of General Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningqi Dai
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Yue Sun
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Honglei Liu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Xiaobing Cheng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Junna Ye
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Qiongyi Hu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Jianfen Meng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Zhuochao Zhou
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Jialin Teng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Yutong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China
| | - Huihui Chi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai, 200025, China.
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13
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Rutter M, Lanyon PC, Grainge MJ, Hubbard R, Bythell M, Stilwell P, Aston J, McPhail S, Stevens S, Pearce FA. COVID-19 infection, admission and death and the impact of corticosteroids among people with rare autoimmune rheumatic disease during the second wave of COVID-19 in England: results from the RECORDER Project. Rheumatology (Oxford) 2023; 62:3828-3837. [PMID: 37018139 PMCID: PMC10691923 DOI: 10.1093/rheumatology/kead150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the second wave of the COVID-19 pandemic in England, and describe the impact of corticosteroids on outcomes. METHODS Hospital Episode Statistics data were used to identify people alive on 1 August 2020 with ICD-10 codes for RAIRD from the whole population of England. Linked national health records were used to calculate rates and rate ratios of COVID-19 infection and death up to 30 April 2021. Primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. NHS Digital and Office for National Statistics general population data were used for comparison. The association between 30-day corticosteroid usage and COVID-19-related death, COVID-19-related hospital admissions and all-cause deaths was also described. RESULTS Of 168 330 people with RAIRD, 9961 (5.92%) had a positive COVID-19 PCR test. The age-standardized infection rate ratio between RAIRD and the general population was 0.99 (95% CI: 0.97, 1.00). 1342 (0.80%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardized mortality rate for COVID-19-related death was 2.76 (95% CI: 2.63, 2.89) times higher than in the general population. There was a dose-dependent relationship between 30-day corticosteroid usage and COVID-19-related death. There was no increase in deaths due to other causes. CONCLUSIONS During the second wave of COVID-19 in England, people with RAIRD had the same risk of COVID-19 infection but a 2.76-fold increased risk of COVID-19-related death compared with the general population, with corticosteroids associated with increased risk.
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Affiliation(s)
- Megan Rutter
- Department of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
| | - Peter C Lanyon
- Department of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
| | - Matthew J Grainge
- Department of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard Hubbard
- Department of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
| | - Mary Bythell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
| | - Peter Stilwell
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
| | - Jeanette Aston
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
| | - Sean McPhail
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
| | - Sarah Stevens
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
| | - Fiona A Pearce
- Department of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- National Congenital Anomaly and Rare Disease Registration Service, National Disease Registration Service, NHS Digital, Leeds, UK
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
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Kow CS, Ramachandram DS, Hasan SS, Thiruchelvam K. Systematic review and meta-analysis of anti-CD20 treatments in patients with COVID-19: an assessment of severe illness and mortality outcomes. Inflammopharmacology 2023; 31:3339-3355. [PMID: 37804462 DOI: 10.1007/s10787-023-01349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND The use of anti-CD20 monoclonal antibodies, such as rituximab and ocrelizumab, has emerged as a matter of concern, in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE We aimed to summarize the overall evidence on the pre-admission/pre-diagnosis use of anti-CD20 among patients with COVID-19 with regards to mortality and severe illness outcomes. METHODS A systematic literature search with no language restriction was performed in electronic databases, including PubMed, Google Scholar, Scopus, and preprint servers (medRxiv, Research Square, SSRN), to identify eligible studies published up to June 13, 2023. The outcomes of interest were the development of severe illness and all-cause mortality. A random-effects model was used to estimate the pooled odds ratio for outcomes of interest using anti-CD20 monoclonal antibodies relative to non-use of anti-CD20 monoclonal antibodies, at 95% confidence intervals. RESULTS Our systematic review and meta-analysis revealed significantly increased odds for development of severe illness (pooled odds ratio 2.95; 95% confidence interval 2.30, 3.78; n = 534,349) and significantly increased odds for mortality (pooled odds ratio 2.14; 95% confidence interval 1.37, 3.35; n = 333,462) with the use of anti-CD20 monoclonal antibodies, relative to non-use of anti-CD20 monoclonal antibodies, in patients with COVID-19. CONCLUSION Healthcare practitioners should exercise caution when prescribing these anti-CD20 monoclonal antibodies during the COVID-19 pandemic to patients who are indicated for these agents, particularly those with underlying conditions like multiple sclerosis or rheumatoid arthritis.
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Affiliation(s)
- Chia Siang Kow
- School of Pharmacy, International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | | | - Syed Shahzad Hasan
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Kaeshaelya Thiruchelvam
- School of Pharmacy, International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
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15
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Mahroum N, Elsalti A, Ozkan MF, Shoenfeld Y. COVID-19 and SLE: Infection and autoimmunity at its best. Lupus 2023; 32:1591-1597. [PMID: 37927085 DOI: 10.1177/09612033231213914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
If one had any doubts before the pandemic regarding the correlation between infections and autoimmunity, COVID-19 left us fascinated on the strong bond between the two entities. The immune and autoimmune reactions seen in patients infected with SARS-CoV-2 have served as a base for this assumption. Later on, the use of immunosuppressants such as systemic glucocorticoids, among other biological agents, turned this assumption to a fact. This was no different when it comes to the vaccines against COVID-19. Through several postulated mechanisms these vaccines, although generally considered safe, are thought to have the potential to result in autoimmune reactions making them not more innocent than the infection itself. When systemic lupus erythematous (SLE) is viewed as a classical autoimmune multisystemic disorder, the connection with SARS-CoV-2 infection and COVID-19 vaccination is of extreme importance. This is because early reports during the pandemic have shown increased rates of SARS-CoV-2 infection among patients known previously to have SLE and much more interestingly, cases of new-onset SLE after COVID-19 have been documented in the literature. Subsequently vaccines against COVID-19, those mRNA-based and adenovirus-vector based, were reported to induce new SLE cases, trigger immune thrombocytopenia or lupus nephritis, two common presentations of SLE, or exacerbate flares. In our paper, we concluded various aspects of available and recent data regarding SLE and COVID-19 as both an infection and vaccination.
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Affiliation(s)
- Naim Mahroum
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Abdulrahman Elsalti
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Fatih Ozkan
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel
- Reichman University, Herzliya, Israel
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Magder LS, Fava A, Goldman D, Petri MA. Does the use of corticosteroids and immunosuppressants increase the risk of COVID-19 infection among people with systemic lupus erythematosus? Lupus Sci Med 2023; 10:e000961. [PMID: 37802601 PMCID: PMC10565333 DOI: 10.1136/lupus-2023-000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE An important clinical question is whether the use of immunosuppressants or corticosteroids increases the risk of incident COVID-19 disease among patients with SLE. To address this question, we examined the incidence of COVID-19 infection in a large SLE cohort. METHODS This study was based on a single-centre cohort of patients with SLE seen quarterly from March 2020 to August 2022. Clinical information from these visits was augmented with information on COVID-19 infections and vaccinations obtained from the electronic medical records and by patient self-report. We compared treated and untreated patients with respect to the incidence of COVID-19 infection per person month. Statistical significance was assessed based on logistic regression models. RESULTS We observed 339 incident cases of COVID-19 experienced over 24 614 person-months of follow-up from 1052 different patients. The risk of infection per person-month of follow-up was similar among those not on prednisone (1.37%), on moderate doses of prednisone (<7 mg/day) (1.44%) and those on higher doses (1.52%) (p=0.87 for difference). We observed an elevated risk among those taking belimumab, however, after adjustment for potential confounding variables, the increased risk was not statistically significant (rate ratio 1.4, 95% CI 0.88 to 2.24, p=0.16) There was no evidence of an increased risk among those taking mycophenolate, methotrexate or azathioprine. CONCLUSION It is reassuring that there was not strong evidence of an increased risk of infection among those taking prednisone or other immunosuppressants. However, given the range of our CIs, moderate effects of these medications on COVID-19 risk cannot be completely ruled out.
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Affiliation(s)
- Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea Fava
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Goldman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle A Petri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kunzler ALF, C. Tsokos G. Infections in Patients with Systemic Lupus Erythematosus: The Contribution of Primary Immune Defects Versus Treatment-Induced Immunosuppression. Eur J Rheumatol 2023; 10:148-158. [PMID: 37850609 PMCID: PMC10765185 DOI: 10.5152/eurjrheum.2023.23068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 10/19/2023] Open
Abstract
Patients with systemic lupus erythematosus experience high rates of infections. The use of immunosuppressive drugs to treat the disease, along with the fact that both the innate and adaptive branches of the immune system are compromised, account for the development of infections. In this communication, we briefly discuss the aberrant function of the immune system in patients with systemic lupus erythematosus and review the occurrence of infections that have been reported in clinical trials conducted to develop new therapeutics. Understanding the immune dysfunction in patients with systemic lupus erythematosus and the appearance of infections while trying to control the disease using immunosuppressive or immunomodulatory drugs should help limit infections and mitigate the associated morbidity and mortality.
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Affiliation(s)
| | - George C. Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Pappa M, Panagiotopoulos A, Thomas K, Fanouriakis A. Systemic Lupus Erythematosus and COVID-19. Curr Rheumatol Rep 2023; 25:192-203. [PMID: 37477841 PMCID: PMC10504107 DOI: 10.1007/s11926-023-01110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE OF REVIEW To describe the current state of knowledge regarding COVID-19 in patients with systemic lupus erythematosus (SLE). We focus on (i) SARS-CoV-2 vaccination uptake, immunogenicity and safety, and (ii) outcomes of COVID-19 in patients with SLE and pertinent risk factors for adverse sequelae. RECENT FINDINGS Notwithstanding the potential concern of patients about possible post-vaccination side-effects, the safety of anti-SARS-CoV-2 vaccines in patients with SLE has been undisputedly confirmed in numerous studies. Humoral immunogenicity is generally attained in SLE, although affected by the use of background immunosuppressive drugs, especially rituximab. The latter has also clearly been implicated with adverse COVID-19 outcomes in SLE, including need for hospitalization, mechanical ventilation and death. Although the wide adoption of vaccination has significantly improved COVID-19 outcomes, patients with SLE continue to pose challenges during the pandemic, mainly owing to administered immunosuppressive medications.
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Affiliation(s)
- Maria Pappa
- 1st Department of Propaedeutic Internal Medicine, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Panagiotopoulos
- 1st Department of Propaedeutic Internal Medicine, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Thomas
- 4th Department of Internal Medicine, "Attikon" University Hospital, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology, "Attikon" University Hospital of Athens, Medical School National and Kapodistrian University of Athens, Athens, Greece.
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19
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Chighizola CB, Suardi I, Carrea G, Argolini L, Gattinara M, Marino A, Pontikaki I, Caporali R, Gerosa M. Anti-SARS-CoV-2 vaccination in adolescent and adult patients with juvenile-onset systemic lupus erythematosus: tolerability and impact on disease activity. Rheumatology (Oxford) 2023; 62:3146-3150. [PMID: 36702464 DOI: 10.1093/rheumatology/kead047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/04/2023] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES JSLE has a severe presentation and a remitting course. Patients with JSLE carry an increased vulnerability to infections, which also act as triggers of disease flare. Thus, vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important tool in JSLE. The objective of this study is to evaluate the tolerability and the safety of anti-SARS-CoV-2 vaccination, including the booster, in a monocentric cohort of JSLE patients. METHODS Clinical records of JSLE patients who received at least one dose of any anti-SARS-CoV-2 vaccine were retrospectively reviewed. Data about disease activity, treatment, anti-SARS-CoV-2 vaccination and COVID-19 infection were collected. RESULTS Sixty-five JSLE patients received at least one dose of anti-SARS-CoV-2 vaccination, while 46 patients completed the schedule with the booster. The rate of mild-moderate adverse events was 66%, mainly comprising fever, fatigue, arthromyalgias and pain at injection site. The rate of adverse events after the booster was similar to that registered after the first two doses. No significant changes after SARS-CoV-2 vaccination in BILAG and SLEDAI were observed. Disease flare rate (mainly LN) after immunization was 10.8%. Flares occurred predominantly in patients with moderate disease activity before immunization; accordingly, SLEDAI ≥4 identified patients at risk of flare while Lupus Low Disease Activity State (LLDAS) plays a protective role against post-vaccination flare. CONCLUSIONS This study confirms that anti-SARS-CoV-2 vaccination in JSLE is well tolerated; a strict clinical monitoring and a thoughtful choice of vaccination timing should be devoted to patients not in LLDAS due to the risk of post-vaccine flare.
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Affiliation(s)
- Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Ilaria Suardi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Giulia Carrea
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | | | | | - Achille Marino
- Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | | | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
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Petri M, Joyce D, Haag K, Fava A, Goldman DW, Zhong D, Xiao S, Milstone A, Magder LS. Effect of Systemic Lupus Erythematosus and Immunosuppressive Agents on COVID-19 Vaccination Antibody Response. Arthritis Care Res (Hoboken) 2023; 75:1878-1885. [PMID: 36714913 PMCID: PMC10387122 DOI: 10.1002/acr.25094] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/03/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The risk of COVID-19 infection is increased in patients with systemic lupus erythematosus (SLE) versus those without SLE. Some immunosuppressive medications increase COVID-19 infection and decrease the efficacy of vaccination. Consensus documents have suggested management strategies for handling immunosuppressive medications to increase vaccine efficacy, but the benefit of such strategies has not been proven. The current study was undertaken to determine the effect of immunosuppressive drugs on vaccine response in SLE. METHODS We collected information on COVID-19 infection, vaccination history, and COVID-19 antibodies in the Hopkins Lupus Cohort. A cohort of health care workers was used for comparison. Outcome measures included SARS-CoV-2 antibody IgG levels after vaccination over time in both cohorts and effect of immunosuppressive medications on postvaccination IgG levels in SLE patients. RESULTS The analysis was based on 365 observations from 334 different patients in the SLE cohort, and 2,235 observations from 1,887 different health care workers. SLE patients taking immunosuppressive medications had lower vaccine IgG levels than SLE patients who were not; but both groups had lower levels than health care workers. Holding mycophenolate for 1 week after vaccination increased postvaccine IgG levels significantly without leading to clinical flares. In multiple variable models, mycophenolate mofetil, tacrolimus, and belimumab all significantly reduced antibody response to vaccination. CONCLUSION SLE patients, regardless of background immunosuppressive therapy, had lower vaccine IgG levels than health care workers. Mycophenolate, tacrolimus, and belimumab significantly reduced IgG response to vaccination. Holding mycophenolate for 1 week improved vaccine efficacy, providing clinical benefit on vaccine response without leading to clinical flares.
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Affiliation(s)
- Michelle Petri
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology
| | - Daniel Joyce
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology
| | - Kristin Haag
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology
| | - Andrea Fava
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology
| | - Daniel W. Goldman
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology
| | - Diana Zhong
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Infectious Diseases
| | - Shaoming Xiao
- Johns Hopkins University School of Medicine, Department of Pediatrics. Division of Infectious Diseases
| | - Aaron Milstone
- Johns Hopkins University School of Medicine, Department of Pediatrics. Division of Infectious Diseases
| | - Laurence S. Magder
- University of Baltimore School of Medicine, Department of Epidemiology and Biostatistics
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21
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Lu KQ, Zhu ZZ, Wei SR, Zeng HS, Mo HY. Systemic lupus erythematosus complicated with cardiovascular disease. Int J Rheum Dis 2023; 26:1429-1431. [PMID: 37485770 DOI: 10.1111/1756-185x.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Ke-Qu Lu
- Department of Rheumatology, Guilin Medical University, Guilin, China
| | - Zhen-Zhen Zhu
- Department of Rheumatology, Guilin Medical University, Guilin, China
| | - Si-Ru Wei
- Department of Rheumatology, Guilin Medical University, Guilin, China
| | - Hua-Song Zeng
- Department of Pediatric Allergy, Immunology & Rheumatology, Women and Children's Medical Center, Guanzhou Medical University, Center and South National Pediatric Medical Center, Guanzhou, China
| | - Han-You Mo
- Department of Rheumatology, The Affiliated Hospital of Guilin Medical University, Guilin, China
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Zeng H, Zhuang Y, Li X, Yin Z, Huang X, Peng H. Exploring the potential common denominator pathogenesis of system lupus erythematosus with COVID-19 based on comprehensive bioinformatics analysis. Front Immunol 2023; 14:1179664. [PMID: 37426642 PMCID: PMC10325730 DOI: 10.3389/fimmu.2023.1179664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Evidences show that there may be a link between SLE and COVID-19. The purpose of this study is to screen out the diagnostic biomarkers of systemic lupus erythematosus (SLE) with COVID-19 and explore the possible related mechanisms by the bioinformatics approach. Methods SLE and COVID-19 datasets were extracted separately from the NCBI Gene Expression Omnibus (GEO) database. The limma package in R was used to obtain the differential genes (DEGs). The protein interaction network information (PPI) and core functional modules were constructed in the STRING database using Cytoscape software. The hub genes were identified by the Cytohubba plugin, and TF-gene together with TF-miRNA regulatory networks were constructed via utilizing the Networkanalyst platform. Subsequently, we generated subject operating characteristic curves (ROC) to verify the diagnostic capabilities of these hub genes to predict the risk of SLE with COVID-19 infection. Finally, a single-sample gene set enrichment (ssGSEA) algorithm was used to analyze immune cell infiltration. Results A total of 6 common hub genes (CDC6, PLCG1, KIF15, LCK, CDC25C, and RASGRP1) were identified with high diagnostic validity. These gene functional enrichments were mainly involved in cell cycle, and inflammation-related pathways. Compared to the healthy controls, abnormal infiltration of immune cells was found in SLE and COVID-19, and the proportion of immune cells linked to the 6 hub genes. Conclusion Our research logically identified 6 candidate hub genes that could predict SLE complicated with COVID-19. This work provides a foothold for further study of potential pathogenesis in SLE and COVID-19.
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Affiliation(s)
- Huiqiong Zeng
- Department of Rheumatology, Shenzhen Futian Hospital for Rheumatic Diseases, Futian District, Shenzhen, Guangdong, China
| | - Yu Zhuang
- Department of Rheumatology and Immunology, Huizhou Central People’s Hospital, Huizhou, Guangdong, China
| | - Xiaojuan Li
- Department of Public Health, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Zhihua Yin
- Department of Rheumatology, Shenzhen Futian Hospital for Rheumatic Diseases, Futian District, Shenzhen, Guangdong, China
| | - Xia Huang
- Department of Xi Yuan Community Health Service Center, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Haiyan Peng
- Department of Rheumatology, Shenzhen Futian Hospital for Rheumatic Diseases, Futian District, Shenzhen, Guangdong, China
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23
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Nguyen Y, Costedoat-Chalumeau N. Serious infections in patients with systemic lupus erythematosus: how can we prevent them? THE LANCET. RHEUMATOLOGY 2023; 5:e245-e246. [PMID: 38251585 DOI: 10.1016/s2665-9913(23)00096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Yann Nguyen
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre, Université Paris Cité, F-75014 Paris, France; Centre de Recherche en Epidémiologie et Statistiques, Unité Inserm 1153, Université de Paris Cité, Paris, France
| | - Nathalie Costedoat-Chalumeau
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre, Université Paris Cité, F-75014 Paris, France; Centre de Recherche en Epidémiologie et Statistiques, Unité Inserm 1153, Université de Paris Cité, Paris, France.
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Salis Z, Gallego B, Sainsbury A. Researchers in rheumatology should avoid categorization of continuous predictor variables. BMC Med Res Methodol 2023; 23:104. [PMID: 37101144 PMCID: PMC10134601 DOI: 10.1186/s12874-023-01926-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Rheumatology researchers often categorize continuous predictor variables. We aimed to show how this practice may alter results from observational studies in rheumatology. METHODS We conducted and compared the results of two analyses of the association between our predictor variable (percentage change in body mass index [BMI] from baseline to four years) and two outcome variable domains of structure and pain in knee and hip osteoarthritis. These two outcome variable domains covered 26 different outcomes for knee and hip combined. In the first analysis (categorical analysis), percentage change in BMI was categorized as ≥ 5% decrease in BMI, < 5% change in BMI, and ≥ 5% increase in BMI, while in the second analysis (continuous analysis), it was left as a continuous variable. In both analyses (categorical and continuous), we used generalized estimating equations with a logistic link function to investigate the association between the percentage change in BMI and the outcomes. RESULTS For eight of the 26 investigated outcomes (31%), the results from the categorical analyses were different from the results from the continuous analyses. These differences were of three types: 1) for six of these eight outcomes, while the continuous analyses revealed associations in both directions (i.e., a decrease in BMI had one effect, while an increase in BMI had the opposite effect), the categorical analyses showed associations only in one direction of BMI change, not both; 2) for another one of these eight outcomes, the categorical analyses suggested an association with change in BMI, while this association was not shown in the continuous analyses (this is potentially a false positive association); 3) for the last of the eight outcomes, the continuous analyses suggested an association of change in BMI, while this association was not shown in the categorical analyses (this is potentially a false negative association). CONCLUSIONS Categorization of continuous predictor variables alters the results of analyses and could lead to different conclusions; therefore, researchers in rheumatology should avoid it.
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Affiliation(s)
- Zubeyir Salis
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Blanca Gallego
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Perth, WA, 6009, Australia.
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25
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Holroyd KB, Conway SE. Central Nervous System Neuroimmunologic Complications of COVID-19. Semin Neurol 2023. [PMID: 37080234 DOI: 10.1055/s-0043-1767713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Autoimmune disorders of the central nervous system following COVID-19 infection include multiple sclerosis (MS), neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, autoimmune encephalitis, acute disseminated encephalomyelitis, and other less common neuroimmunologic disorders. In general, these disorders are rare and likely represent postinfectious phenomena rather than direct consequences of the SARS-CoV-2 virus itself. The impact of COVID-19 infection on patients with preexisting neuroinflammatory disorders depends on both the disorder and disease-modifying therapy use. Patients with MS do not have an increased risk for severe COVID-19, though patients on anti-CD20 therapies may have worse clinical outcomes and attenuated humoral response to vaccination. Data are limited for other neuroinflammatory disorders, but known risk factors such as older age and medical comorbidities likely play a role. Prophylaxis and treatment for COVID-19 should be considered in patients with preexisting neuroinflammatory disorders at high risk for developing severe COVID-19.
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Affiliation(s)
- Kathryn B Holroyd
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah E Conway
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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Maynard N, Armstrong AW. The Impact of Immune-Modulating Treatments for Dermatological Diseases on the Risk of Infection with SARS-CoV-2 and Outcomes Associated with COVID-19 Illness. CURRENT DERMATOLOGY REPORTS 2023; 12:45-55. [PMID: 37304177 PMCID: PMC10068706 DOI: 10.1007/s13671-023-00385-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 04/05/2023]
Abstract
Purpose of Review Immune-modulating treatments are used in dermatology for a variety of conditions. The authors aim to review the data regarding the safety of these treatments during the COVID-19 pandemic, namely the risk of infection with SARS-CoV-2 and the outcomes associated with COVID-19-related illness. Recent Findings Several large-scale studies found no increased risk of COVID-19 infection for patients on TNF-α inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, IL-23 inhibitors, dupilumab, and methotrexate. They also found that these patients did not have worse outcomes when infected with COVID-19. The data regarding JAK inhibitors, rituximab, prednisone, cyclosporine, mycophenolate mofetil, and azathioprine are more mixed. Summary Based on current research and guidelines from the American Academy of Dermatology and the National Psoriasis Foundation, dermatology patients on immune-modulating therapies can continue treatment during the COVID-19 pandemic when they are not infected with SARS-CoV-2. For patients who have COVID-19, guidelines encourage individualized assessment of the benefits and risks of continuing or temporarily withholding treatment.
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Affiliation(s)
- Nicole Maynard
- Keck School of Medicine of USC, 1975 Zonal Avenue, KAM 510, MC 9034, Los Angeles, CA 90089 USA
| | - April W. Armstrong
- Keck School of Medicine of USC, 1975 Zonal Avenue, KAM 510, MC 9034, Los Angeles, CA 90089 USA
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27
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Managing immunosuppression in vasculitis patients in times of COVID-19. Rheum Dis Clin North Am 2023. [PMCID: PMC10011035 DOI: 10.1016/j.rdc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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28
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Isnardi CA, Soriano ER, Graf C, de la Vega MC, Pons-Estel BA, Roberts K, Quintana R, Gomez G, Yazdany J, Saurit V, Báez RM, Coello VVC, Pisoni CN, Berbotto G, Vivero F, Zelaya MD, Haye Salinas MJ, Reyes Torres ÁA, Ornella S, Nieto RE, Maldonado FN, Gamba MJ, Severina MDLÁ, Tissera Y, Alba P, Cogo AK, Alle G, Gobbi C, Baños A, Velozo E, Pera M, Tanten R, Albiero JA, Maldonado Ficco H, Martire MV, Elkin MSG, Cosatti M, Cusa MA, Pereira D, Savio VG, Pons-Estel GJ. Does the Use of Immunosuppressive Drugs Impact on SARS-CoV-2 Infection Outcome? Data From A National Cohort of Patients With Immune-Mediated Inflammatory Diseases (SAR-COVID Registry). J Clin Rheumatol 2023; 29:68-77. [PMID: 36454054 PMCID: PMC9940788 DOI: 10.1097/rhu.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND/OBJECTIVE This study describes the impact of immunomodulatory and/or immunosuppressive (IM/IS) drugs in the outcomes of COVID-19 infection in a cohort of patients with immune-mediated inflammatory diseases (IMIDs). METHODS Adult patients with IMIDs with a confirmed SARS-CoV-2 infection were included. Data were reported by the treating physician between August 13, 2020 and July 31, 2021. Sociodemographic data, comorbidities, and DMARDs, as well as clinical characteristics, complications, and treatment of the SARS-CoV-2 infection, were recorded. Descriptive analysis and multivariable logistic regression models were carried out. RESULTS A total of 1672 patients with IMIDs were included, of whom 1402 were treated with IM/IS drugs. The most frequent diseases were rheumatoid arthritis (47.7%) and systemic lupus erythematosus (18.4%). COVID-19 symptoms were present in 95.2% of the patients. A total of 461 (27.6%) patients were hospitalized, 8.2% were admitted to the intensive care unit, and 4.4% died due to COVID-19.Patients without IM/IS treatment used glucocorticoids less frequently but at higher doses, had higher levels of disease activity, were significantly older, were more frequently hospitalized, admitted to the intensive care unit, and died due to COVID-19. After adjusting for these factors, treatment with IM/IS drugs was not associated with a worse COVID-19 outcome (World Health Organization-Ordinal Scale ≥5) (odds ratio, 1.24; 95% confidence interval, 0.73-2.06). CONCLUSIONS SAR-COVID is the first multicenter Argentine registry collecting data from patients with rheumatic diseases and SARS-CoV-2 infection. After adjusting for relevant covariates, treatment with IM/IS drugs was not associated with severe COVID-19 in patients with IMIDs. STUDY REGISTRATION This study has been registered in ClinicalTrials.gov under the number NCT04568421.
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Affiliation(s)
| | | | - Cesar Graf
- Argentine Society of Rheumatology, Argentina
| | | | | | | | | | | | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA
| | | | | | | | - Cecilia Nora Pisoni
- Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires
| | - Guillermo Berbotto
- Hospital Escuela Eva Perón, Granadero Baigorria
- Sanatorio Británico, Chief of the Rheumatology Service, Rosario, Santa Fe
| | | | | | | | | | | | - Romina Estefanía Nieto
- Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Argentina
- Hospital Escuela Eva Perón, Granadero Baigorria
- Hospital Intendente Carrasco, Rosario, Santa Fe
| | | | | | | | | | - Paula Alba
- Hospital Córdoba, Córdoba
- Hospital Materno-Neonatal
- Hospital Italiano de Córdoba, Córdoba, Córdoba
| | - Adriana Karina Cogo
- Hospital Interzonal Luis Guemes, Haedo
- Hospital San Juan de Dios, Castelar, Buenos Aires
| | - Gelsomina Alle
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires
| | - Carla Gobbi
- Cátedra de Clínica Médica I, Hospital Córdoba, FCM, UNC, Córdoba, Córdoba
| | - Andrea Baños
- Fundación CIDEA, Ciudad Autónoma de Buenos Aires
- Sanatorio Adventista del Plata, Libertador San Martín, Entre Ríos
| | - Edson Velozo
- Sanatorio Adventista del Plata, Libertador San Martín, Entre Ríos
| | - Mariana Pera
- Hospital Ángel C Padilla, San Miguel de Tucumán, Tucumán
| | - Romina Tanten
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires
| | | | | | | | | | - Micaela Cosatti
- Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires
| | | | | | - Verónica G. Savio
- Hospital Córdoba, Córdoba
- Consultora Integral de Salud CMP, Córdoba, Córdoba
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Meng R, Zhang N, Yang F, Xu Z, Wu Z, Du Y. Blood transcriptome analysis revealed the crosstalk between severe COVID-19 and systemic lupus erythematosus. J Infect 2023; 86:e104-e106. [PMID: 36775249 PMCID: PMC9916182 DOI: 10.1016/j.jinf.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Affiliation(s)
| | - Ning Zhang
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China,First School of Clinical Medicine, Anhui Medical University, Hefei 230032, China,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Feixiang Yang
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China,First School of Clinical Medicine, Anhui Medical University, Hefei 230032, China,Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Zhihao Xu
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China,First School of Clinical Medicine, Anhui Medical University, Hefei 230032, China
| | - Zhengyang Wu
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China,First School of Clinical Medicine, Anhui Medical University, Hefei 230032, China
| | - Yinan Du
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China.
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30
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Patil A, Shobha V, Shenoy P, S C, Kumar S, Daware M, Haridas V, Janardana R, Pinto B, Kodishala C, Ramaswamy S, S N, Jain V, Singh YP, Singhai S, C S, Jois R, Rao VK, Dharmapalaiah C, KN S, Balebail D. Risk factors associated with COVID-19 in systemic lupus erythematosus: Results from a longitudinal prospective cohort. Lupus 2023; 32:560-564. [PMID: 36731873 PMCID: PMC9899665 DOI: 10.1177/09612033231155837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Patients with SLE (systemic lupus erythematosus) have a higher risk of infection due to dysregulated immune system as well as long-term use of immunosuppressants (IS). This could influence the risk of COVID-19 and its outcome. METHODS We conducted a longitudinal prospective study across 15 rheumatology centres during the first wave of the pandemic to understand the risk factors contributing to COVID-19 in SLE patients. During the 6 months follow-up, those who tested positive for COVID-19, their clinical course and outcome information were recorded. RESULTS Through the study period (April-December 2020), 36/1379 lupus patients (2.9%) developed COVID-19. On analysing the COVID-19 positive versus negative cohort during the study period, male gender (adjusted RR 3.72, 95% C.I. 1.85,7.51) and diabetes (adjusted RR 2.94, 95% C.I. 1.28, 6.79) emerged as the strongest risk factors for COVID-19, in the adjusted analysis. There was no significant influence of organ involvement, hydroxychloroquine, glucocorticoid dosage (prednisolone< 7.5 mg or ≥ 7.5 mg/day) or IS on the risk of COVID-19. There was only one death (1/36) among the lupus patients due to COVID-19. CONCLUSION Traditional risk factors rather than lupus disease process or IS influenced the risk of COVID-19 in our cohort.
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Affiliation(s)
| | - Vineeta Shobha
- St John’s Medical College
Hospital, Bangalore, India,Vineeta Shobha, Professor and Head,
Department of Clinical Immunology and Rheumatology, St John’s Medical College
Hospital, Sarjapur Road, Bengaluru-560034, India.
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31
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Kalunian KC, Furie R, Morand EF, Bruce IN, Manzi S, Tanaka Y, Winthrop K, Hupka I, Zhang LJ, Werther S, Abreu G, Hultquist M, Tummala R, Lindholm C, Al-Mossawi H. A Randomized, Placebo-Controlled Phase III Extension Trial of the Long-Term Safety and Tolerability of Anifrolumab in Active Systemic Lupus Erythematosus. Arthritis Rheumatol 2023; 75:253-265. [PMID: 36369793 PMCID: PMC10098934 DOI: 10.1002/art.42392] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore long-term safety and tolerability of anifrolumab 300 mg compared with placebo in patients with systemic lupus erythematosus (SLE) who completed a Treatment of Uncontrolled Lupus via the Interferon Pathway (TULIP) trial and enrolled in the placebo-controlled 3-year long-term extension (LTE) study (ClinicalTrials.gov identifier: NCT02794285). METHODS In the blinded LTE study, patients continued anifrolumab 300 mg, switched from anifrolumab 150 mg to 300 mg, or were re-randomized from placebo to receive either anifrolumab 300 mg or to continue placebo, administered every 4 weeks. Primary comparisons in the LTE study were between patients who received anifrolumab 300 mg or placebo throughout the TULIP and LTE studies. For rare safety events, comparisons included patients who received any anifrolumab dose during TULIP or LTE. When exposure differed, exposure-adjusted incidence rates (EAIRs) per 100 patient-years were calculated. RESULTS In the LTE study, EAIRs of serious adverse events (SAEs) were 8.5 with anifrolumab compared with 11.2 with placebo; likewise, EAIRs of AEs leading to treatment discontinuation were 2.5 versus 3.2, respectively. EAIRs of non-opportunistic serious infections were comparable between groups (3.7 with anifrolumab versus 3.6 with placebo). Exposure-adjusted event rates of COVID-related AEs, including asymptomatic infections, were 15.5 with anifrolumab compared with 9.8 with placebo. No COVID-related AEs occurred in fully vaccinated individuals. EAIRs of malignancy and major acute cardiovascular events were low and comparable between groups. Anifrolumab was associated with lower cumulative glucocorticoid use and greater mean improvement in the SLE Disease Activity Index 2000, compared with placebo. CONCLUSION This LTE study represents the longest placebo-controlled clinical trial performed in SLE to date. No new safety findings were identified in the LTE study, supporting the favorable benefit-risk profile of anifrolumab for patients with moderate-to-severe SLE receiving standard therapy.
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Affiliation(s)
- Kenneth C Kalunian
- Division of Rheumatology, Allergy and Immunology, University of California San Diego School of Medicine, La Jolla, California
| | - Richard Furie
- Division of Rheumatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Eric F Morand
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK
| | - Susan Manzi
- Lupus Center of Excellence, Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Kevin Winthrop
- School of Public Health at Oregon Health and Science University, Portland, Oregon
| | - Ihor Hupka
- Clinical Development, Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Warsaw, Poland
| | - Lijin Jinny Zhang
- Global Patient Safety, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | - Shanti Werther
- Global Patient Safety, Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Gabriel Abreu
- Biometrics, Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Micki Hultquist
- Clinical Development, Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | - Raj Tummala
- Clinical Development, Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland
| | - Catharina Lindholm
- Clinical Development, Late Respiratory & Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Hussein Al-Mossawi
- Clinical Development, Late Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
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Abstract
COVID-19 can cause acute kidney injury and may cause or exacerbate chronic kidney diseases, including glomerular diseases. SARS-CoV-2 infection of kidney cells has been reported, but it remains unclear if viral infection of kidney cells causes disease. The most important causes of kidney injury in patients with COVID-19 include impaired renal perfusion and immune dysregulation. Chronic kidney disease, especially kidney failure with kidney replacement therapy and kidney transplant, is associated with markedly increased COVID-19 mortality. Persons with severe kidney disease have been excluded from most clinical trials of COVID-19 therapies, so therapeutic approaches must be extrapolated from studies of patients without kidney disease. Some medications used to treat COVID-19 should be avoided or used at reduced dosages in patients with severe kidney disease and in kidney transplant recipients. Additional research is needed to determine the optimal strategies to prevent and treat COVID-19 in patients with kidney disease.
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Affiliation(s)
- Maureen Brogan
- Division of Nephrology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA;
| | - Michael J Ross
- Division of Nephrology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA; .,Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA
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Lupu A, Miron IC, Gavrilovici C, Raileanu AA, Starcea IM, Ioniuc I, Azoicai A, Mocanu A, Butnariu LI, Dragan F, Lupu VV. Pediatric Systemic Lupus Erythematous in COVID-19 Era. Viruses 2023; 15:v15020272. [PMID: 36851487 PMCID: PMC9966057 DOI: 10.3390/v15020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Pediatric systemic lupus erythematosus is a chronic autoimmune disorder with a highly variable course and prognosis. It results in functional abnormalities in the immune system due to intrinsic factors and the use of immunosuppressive therapies associated with underlying comorbidities seem to increase the risk of severe COVID-19 and poor outcomes of the disease in pediatric systemic lupus erythematosus (SLE) patients. The aim of this review is to obtain a better understanding of the existing link between this new viral infection and pediatric lupus. We have analyzed the characteristics of newly diagnosed cases of pediatric SLE following COVID-19 which have been reported in the literature and which describe the impact that COVID-19 has on patients already suffering with pediatric SLE.
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Affiliation(s)
- Ancuta Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Cristina Gavrilovici
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Adam Raileanu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.A.R.); (I.M.S.); (I.I.); (F.D.)
| | - Iuliana Magdalena Starcea
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.A.R.); (I.M.S.); (I.I.); (F.D.)
| | - Ileana Ioniuc
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.A.R.); (I.M.S.); (I.I.); (F.D.)
| | - Alice Azoicai
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adriana Mocanu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- Mother and Child Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
- Correspondence: (A.A.R.); (I.M.S.); (I.I.); (F.D.)
| | - Vasile Valeriu Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Ugarte-Gil MF, Fuentes-Silva Y, Pimentel-Quiroz VR, Pons-Estel GJ, Quintana R, Pons-Estel BA, Alarcón GS. Global excellence in rheumatology in Latin America: The case of systemic lupus erythematosus. Front Med (Lausanne) 2023; 9:988191. [PMID: 36714141 PMCID: PMC9874001 DOI: 10.3389/fmed.2022.988191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
Systemic lupus erythematosus (SLE) affects more severely non-White populations, due to their genetic background and sociodemographic characteristics. Several studies have evaluated Latin American SLE patients to determine their genetic and clinical characteristics as well as prognostic factors; these studies have not only allowed the development of treatment guidelines aimed at the region but also to support regional and global projects. Additionally, educational activities in Spanish and Portuguese have been started to reduce our patients' health illiteracy. Despite the relatively low research output from Latin American countries, we consider that studies from our region coupled with the networks developed to increase our capabilities, could be a model for other rare autoimmune diseases.
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Affiliation(s)
- Manuel F. Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, School of Medicine, Universidad Científica del Sur, Lima, Peru,Department Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru,*Correspondence: Manuel F. Ugarte-Gil,
| | | | - Victor R. Pimentel-Quiroz
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, School of Medicine, Universidad Científica del Sur, Lima, Peru,Department Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Guillermo J. Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Rosana Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Bernardo A. Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Graciela S. Alarcón
- Marnix E. Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States,Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
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Mathew J, Jain S, Susngi T, Naidu S, Dhir V, Sharma A, Jain S, Sharma SK. Predictors of COVID-19 severity and outcomes in Indian patients with rheumatic diseases: a prospective cohort study. Rheumatol Adv Pract 2023; 7:rkad025. [PMID: 36908302 PMCID: PMC9995091 DOI: 10.1093/rap/rkad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/17/2022] [Indexed: 03/06/2023] Open
Abstract
Objective There is dearth of data regarding the outcomes of coronavirus disease 2019 (COVID-19) among rheumatic and musculoskeletal disease (RMD) patients from Southeast Asia. We report the clinicodemographic profile and identify predictors of COVID-19 outcomes in a large cohort of Indian RMD patients. Methods This prospective cohort study, carried out at the Postgraduate Institute of Medical Education and Research, Chandigarh (a tertiary care centre in India), included RMD patients affected with COVID-19 between April 2020 and October 2021. Demographic and clinical and laboratory details of COVID-19 and underlying RMD were noted. Predictors of mortality, hospitalization and severe COVID-19 were identified using stepwise multivariable logistic regression. Results A total of 64 severe acute respiratory syndrome coronavirus-2-infected RMD patients [age 41.5 (19-85) years; 46 (72%) females] were included. Eighteen (28%) patients had severe COVID-19. Twenty-three (36%) required respiratory support [11 (17%) required mechanical ventilation]. Thirty-six (56%) patients required hospitalization [median duration of stay 10 (1-42) days]; 17 (27%) required intensive care unit admission. Presence of co-morbidities [odds ratio (OR) = 4.5 (95% CI: 1.4, 14.7)] was found to be an independent predictor of COVID-19 severity. Co-morbidities [OR = 10.7 (95% CI: 2.5, 45.4)] and underlying lupus [OR = 7.0 (95% CI: 1.2, 40.8)] were independently associated with COVID-19 hospitalization. Ongoing rheumatic disease activity [OR = 6.8 (95% CI: 1.3, 35.4)] and underlying diagnosis of lupus [OR = 7.1 (95% CI: 1.2, 42.4)] and SSc [OR = 9.5 (95% CI: 1.5, 61.8)] were found to be strong independent predictors of mortality. Age, sex, underlying RMD-associated interstitial lung disease and choice of immunosuppressive therapy were not associated with COVID-19 severity or adverse outcomes. Conclusion The presence of co-morbidities was independently associated with COVID-19 severity and hospitalization. Ongoing rheumatic disease activity and the presence of lupus or SSc independently predicted mortality. Age, sex, type of immunosuppressive therapy and presence of RMD-associated interstitial lung disease did not affect COVID-19 severity or outcomes in Indian RMD patients.
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Affiliation(s)
- Jithin Mathew
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Terence Susngi
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research,Chandigarh, India
| | - Shankar Naidu
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shefali Khanna Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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36
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Ugarte-Gil MF, Alarcón GS, Seet AM, Izadi Z, Montgomery AD, Duarte-García A, Gilbert EL, Valenzuela-Almada MO, Wise L, Sparks JA, Hsu TYT, D'Silva KM, Patel NJ, Sirotich E, Liew JW, Hausmann JS, Sufka P, Grainger R, Bhana S, Wallace Z, Jacobsohn L, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Machado PM, Robinson PC, Gianfrancesco M, Yazdany J. Association Between Race/Ethnicity and COVID-19 Outcomes in Systemic Lupus Erythematosus Patients From the United States: Data From the COVID-19 Global Rheumatology Alliance. Arthritis Care Res (Hoboken) 2023; 75:53-60. [PMID: 36239292 PMCID: PMC9874592 DOI: 10.1002/acr.25039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the association between race/ethnicity and COVID-19 outcomes in individuals with systemic lupus erythematosus (SLE). METHODS Individuals with SLE from the US with data entered into the COVID-19 Global Rheumatology Alliance registry between March 24, 2020 and August 27, 2021 were included. Variables included age, sex, race, and ethnicity (White, Black, Hispanic, other), comorbidities, disease activity, pandemic time period, glucocorticoid dose, antimalarials, and immunosuppressive drug use. The ordinal outcome categories were: not hospitalized, hospitalized with no oxygenation, hospitalized with any ventilation or oxygenation, and death. We constructed ordinal logistic regression models evaluating the relationship between race/ethnicity and COVID-19 severity, adjusting for possible confounders. RESULTS We included 523 patients; 473 (90.4%) were female and the mean ± SD age was 46.6 ± 14.0 years. A total of 358 patients (74.6%) were not hospitalized; 40 patients (8.3%) were hospitalized without oxygen, 64 patients (13.3%) were hospitalized with any oxygenation, and 18 (3.8%) died. In a multivariable model, Black (odds ratio [OR] 2.73 [95% confidence interval (95% CI) 1.36-5.53]) and Hispanic (OR 2.76 [95% CI 1.34-5.69]) individuals had higher odds of more severe outcomes than White individuals. CONCLUSION Black and Hispanic individuals with SLE experienced more severe COVID-19 outcomes, which is consistent with findings in the US general population. These results likely reflect socioeconomic and health disparities and suggest that more aggressive efforts are needed to prevent and treat infection in this population.
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Affiliation(s)
- Manuel F Ugarte-Gil
- Universidad Cientifica del Sur and Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Graciela S Alarcón
- Heersink School of Medicine, University of Alabama at Birmingham, and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | | | | | | | - Leanna Wise
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tiffany Y-T Hsu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristin M D'Silva
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Naomi J Patel
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Emily Sirotich
- McMaster University, Hamilton, and Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Jean W Liew
- Boston University School of Medicine, Boston, Massachusetts
| | - Jonathan S Hausmann
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Zachary Wallace
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal, and European League Against Rheumatism Standing Committee of People with Arthritis/Rheumatism in Europe, Kilchberg, Switzerland
| | - Kimme L Hyrich
- University of Manchester, National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | - Saskia Lawson-Tovey
- University of Manchester, National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Manchester Academic Health Science Centre, Manchester, UK
| | - Lianne Kearsley-Fleet
- University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | | | - Pedro M Machado
- University College London, National Institute for Health Research 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
| | - Philip C Robinson
- University of Queensland School of Clinical Medicine, Herston, and Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland, Australia
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Siegel CH, Choi JM, D'Angelo D, Christos P, Lally L, Navarro-Millan I, Cooke J, Goyal P, Mandl LA, Barbhaiya M. Outcomes of COVID-19 and Factors Associated With Its Severity Among Hospitalized Patients With and Without Systemic Rheumatic Disease During the First Wave of the Pandemic in New York City. J Clin Rheumatol 2023; 29:7-15. [PMID: 35905465 PMCID: PMC9803346 DOI: 10.1097/rhu.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE Conflicting data exist regarding whether patients with systemic rheumatic disease (SRD) experience more severe outcomes related to COVID-19. Using data from adult patients hospitalized with COVID-19 in New York City during the first wave of the pandemic, we evaluated whether patients with SRD were at an increased risk for severe outcomes. METHODS We conducted a medical records review study including patients aged ≥18 years with confirmed SARS-CoV-2 infection hospitalized at 3 NewYork-Presbyterian sites, March 3-May 15, 2020. Inverse probability of treatment weighting was applied to a multivariable logistic regression model to assess the association between SRD status and the composite of mechanical ventilation, intensive care unit admission, or death. RESULTS Of 3710 patients hospitalized with COVID-19 (mean [SD] age, 63.7 [17.0] years; 41% female, 29% White, and 34% Hispanic/Latinx), 92 (2.5%) had SRD. Patients with SRD had similar age and body mass index but were more likely to be female, ever smokers, and White or Black, compared with those without SRD. A higher proportion of patients with versus without SRD had hypertension and pulmonary disease, and used hydroxychloroquine, corticosteroids, and immunomodulatory/immunosuppressive medications before admission. In the weighted multivariable analysis, patients with SRD had an odds ratio of 1.24 (95% confidence interval, 1.10-1.41; p < 0.01) for the composite of mechanical ventilation, intensive care unit admission, or death, compared with patients without SRD. CONCLUSIONS During the initial peak of the pandemic in New York City, patients with versus without SRD hospitalized with COVID-19 had a 24% increased likelihood of having severe COVID-19 after multivariable adjustment.
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Affiliation(s)
- Caroline H. Siegel
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Jacky M. Choi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Debra D'Angelo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Paul Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Lindsay Lally
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Iris Navarro-Millan
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Joseph Cooke
- Department of Medicine, Weill Cornell Medicine
- Department of Medicine, NewYork-Presbyterian/Queens, Queens, NY
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine
| | - Lisa A. Mandl
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
| | - Medha Barbhaiya
- From the Division of Rheumatology, Hospital for Special Surgery
- Department of Medicine, Weill Cornell Medicine
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Zhang-Sun J, Kirou RA, Kirou KA. Low Peripheral B-Cell Counts in Patients With Systemic Rheumatic
Diseases Due to Treatment With Belimumab and/or Rituximab Are Associated With
Low Antibody Responses to Primary COVID-19 Vaccination. HSS J 2022; 19:180-186. [PMID: 37051614 PMCID: PMC9760510 DOI: 10.1177/15563316221142846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022]
Abstract
Background: Immunosuppressive agents inhibit COVID-19 vaccine
antibody (Ab) responses in patients with systemic rheumatic diseases. Rituximab
may fully block Ab responses when B cells become undetected. The effect of
detected but low number of B cells due to treatment with a B-cell agent
(belimumab and/or rituximab) has not been established. Purpose:
We sought to examine whether there is an association between a low number of B
cells due to treatment with belimumab and/or rituximab and impaired primary
COVID-19 vaccination spike Ab responses in patients with systemic rheumatic
diseases. Methods: We retrospectively examined Ab responses to
COVID-19 vaccinations, especially in relation to B-cell counts after treatment
with belimumab and/or rituximab, in 58 patients with systemic rheumatic
diseases: 22 on and 36 not on B-cell agents. We used Kruskal-Wallis and
Mann-Whitney U tests for comparison of Ab values between the
groups and Fisher exact test for relative risk calculations.
Results: Median (interquartile range) postvaccination Ab
responses were lower in patients on versus those not on B-cell agents: 3.91
(0.77–20.00) versus 20.00 (14.32–20.00), respectively. Among patients on
belimumab and/or rituximab, Ab responses of less than 25% of the assay’s upper
limit were exclusively observed in those with B-cell counts lower than 40/µL.
Patients with B-cell counts lower than 40/µL exhibit a relative risk of 6.092
(95% CI: 2.75–14.24) for Ab responses of less than 25% of the upper limit
compared with patients not on B-cell agents. This relative risk remained
significant, even after excluding patients with undetected B cells.
Conclusion: This retrospective study found an association
between low B-cell counts (less than 40/µL) and decreased Ab responses to
primary COVID-19 vaccination in patients with systemic rheumatic diseases
treated with belimumab and/or rituximab. Despite the small number of patients
studied, these findings add to the accumulating evidence on the importance of
B-cell count in predicting spike Ab responses to COVID-19 vaccination.
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Affiliation(s)
| | | | - Kyriakos A. Kirou
- Hospital for Special Surgery, New York,
NY, USA
- Weill Cornell Medicine, New York, NY,
USA
- Kyriakos A. Kirou, MD, Hospital for Special
Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Mehta P, Gasparyan AY, Zimba O, Kitas GD, Yessirkepov M. Interplay of diabetes mellitus and rheumatic diseases amidst the COVID-19 pandemic: influence on the risk of infection, outcomes, and immune responses. Clin Rheumatol 2022; 41:3897-3913. [PMID: 36076125 PMCID: PMC9458477 DOI: 10.1007/s10067-022-06365-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022]
Abstract
Outcomes of COrona VIrus Disease-19 (COVID-19) in patients with rheumatic diseases (RDs) reported in various studies are heterogenous owing to the influence of age and comorbidities which have a significant bearing on the infection risk, severity, morbidity, and mortality. Diabetes mellitus (DM) and RDs are closely linked with underlying pathobiology and treatment of RDs affecting the risk for DM as well as the glycemic control. Hence, we undertook this narrative review to study the influence of DM on outcomes of COVID-19 in patients with RDs. Additionally, aspects of patient attitudes and immune response to COVID-19 vaccination were also studied. The databases of MEDLINE/PubMed, Scopus, and Directory of Open Access Journals (DOAJ) were searched for relevant articles. Studies from mixed cohorts revealed insufficient data to comment on the influence of DM on the risk of infection, while most studies showed twice the odds for hospitalization and mortality with DM. Specific cohorts of rheumatoid arthritis and systemic lupus erythematosus revealed a similar association. Poor health was noted in patients with spondyloarthritis and DM during the pandemic. The presence of DM did not affect patient attitudes towards vaccination and did not predispose to additional vaccine-related adverse effects. Immune response to inactivated vaccines was reduced but mRNA vaccines were maintained in patients with DM. Detailed assessment of DM with its duration, end-organ damage, and glycemic control along with a focused association of DM with various aspects of COVID-19 like risk, hospitalization, severity, mortality, post-COVID sequelae, immune response to infection, and vaccination are needed in the future. Key Points • Diabetes mellitus is associated with the severity of infection, COVID-19-related hospitalization, and mortality in rheumatic diseases across most studies but studies analyzing its specific role are lacking. • Poor outcomes of COVID-19 in RA and poor health in spondyloarthritis are strongly associated with diabetes mellitus. • Diabetes mellitus may negatively influence the humoral response to inactivated vaccines but does not seem to affect the immune responses to mRNA vaccines. • Diabetes mellitus does not influence the attitude towards vaccination or deviation from the prescribed medications during the pandemic.
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Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK.
| | - Olena Zimba
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - George D Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11226865. [PMID: 36431342 PMCID: PMC9693294 DOI: 10.3390/jcm11226865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
The ongoing chronic use of hydroxychloroquine or chloroquine (HCQ/CQ) in rheumatic patients might impact their outcomes after a SARS-CoV-2 infection. Therefore, we sought to assess the mortality in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection through a comparison between individuals chronically using HCQ/CQ with those not taking these drugs. We performed a systematic review and meta-analysis of studies on PubMed, Embase, and Cochrane Central. We included full-length reports, prospective observational cohorts, and clinical trials of adult patients (aged ≥ 18 years) who were diagnosed with a COVID-19 infection. Case studies, case series, letters, comments, and editorials were excluded. The main outcome was all-cause mortality. This study is registered with PROSPERO (CRD42022341678). We identified 541 studies, of which 20 studies were included, comprising 236,997 patients. All-cause mortality was significantly lower in patients with prior chronic use of HCQ/CQ compared to those with no previous usage (OR 0.76; 95% CI 0.62-0.94; p = 0.01). There was a considerably lower incidence of hospitalization among patients with chronic HCQ/CQ use compared to their counterparts without HCQ/CQ usage (OR 0.80; 95% CI 0.65-0.99; p = 0.04). All-cause mortality and hospitalization were significantly lower in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection.
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Carvalho JS, dos Reis Neto ET, Kakehasi AM, Ribeiro SLE, Studart SAS, Martins FP, Cavalheiro do Espírito Santo R, Ranzolin A, Fernandino DC, Dinis VG, Sato EI, Resende GG, Marinho A, Mariz HA, Sacilotto NC, Ribeiro FM, Shinjo SK, Dias LH, Yazbek MA, Omura F, Rached THS, Gomides APM, Marques CDL, Pillegi GCS, Mota LMH, Pinheiro MM, Monticielo OA, Xavier RM, Ferreira GA. Factors associated with poor outcomes in SLE patients with COVID-19: Data from ReumaCoV-Brazil register. Lupus 2022; 32:42-53. [PMID: 36300790 PMCID: PMC9614598 DOI: 10.1177/09612033221135884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate factors associated with COVID-19 severity outcomes in patients with systemic lupus erythematosus (SLE). METHODS This was a cross-sectional analysis of baseline data of a prospective, multi-stage cohort study-"The ReumaCoV Brazil"-designed to monitor patients with immune-mediated rheumatologic disease (IMRD) during the SARS-CoV-2 pandemic. SLE adult patients with COVID-19 were compared with those without COVID-19. SLE activity was evaluated by the patient global assessment (PGA) and SLE Disease Activity Index 2000 (SLEDAI-2K). RESULTS 604 SLE patients were included, 317 (52.4%) with COVID-19 and 287 (47.6%) in the control group. SLE COVID-19 patients reported a lower frequency of social isolation and worked more frequently as health professionals. There was no difference in the mean SLEDAI-2K score between groups in the post-COVID-19 period (5.8 [8.6] vs. 4.5 [8.0]; p = 0.190). However, infected patients reported increased SLE activity according to the Patient Global Assessment (PGA) during this period (2.9 [2.9] vs. 2.3 [2.6]; p = 0.031. Arterial hypertension (OR 2.48 [CI 95% 1.04-5.91], p = 0.041), cyclophosphamide (OR 14.32 [CI 95% 2.12-96.77], p = 0.006), dyspnea (OR: 7.10 [CI 95% 3.10-16.23], p < 0.001) and discontinuation of SLE treatment medication during infection (5.38 [CI 95% 1.97-15.48], p = 0.002), were independently associated with a higher chance of hospitalization related to COVID-19. Patients who received telemedicine support presented a 67% lower chance of hospitalization (OR 0.33 [CI 95% 0.12-0.88], p = 0.02). CONCLUSION Hypertension and cyclophosphamide were associated with a severe outcome, and telemedicine can be a useful tool for SLE patients with COVID-19.
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Affiliation(s)
- Joana S Carvalho
- Programa de Pós-graduação em Ciências Aplicadas a Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil,Joana S Carvalho, Programa de Pós-graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Alfredo Balena avenue, 190. Belo Horizonte-MG 13130-100, Brazil.
| | | | - Adriana M Kakehasi
- Programa de Pós-graduação em Ciências Aplicadas a Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra LE Ribeiro
- Faculdade de Medicina da Universidade Federal do Amazonas, Manaus, Brazil
| | | | - Francielle P Martins
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Rafaela Cavalheiro do Espírito Santo
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Universidade Federal do Rio Grande do Sul, Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Porto Alegre, Brazil
| | | | - Diana C Fernandino
- Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | - Emília I Sato
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo G Resende
- Programa de Pós-graduação em Ciências Aplicadas a Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Henrique A Mariz
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Nathália C Sacilotto
- Instituto de Assistência Médica ao Servidor Público Estadual de S. Paulo, São Paulo, Brazil
| | - Francinne M Ribeiro
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samuel K Shinjo
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Laiza H Dias
- Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Michel A Yazbek
- Hospital de Clínicas, Universidade Estadual de Campinas, Campinas, Brazil
| | - Felipe Omura
- Clínica Omura Medicina Diagnóstica, São Paulo, Brazil
| | - Thiago HS Rached
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | | | - Claudia DL Marques
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Lícia MH Mota
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Marcelo M Pinheiro
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Odirlei A Monticielo
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Universidade Federal do Rio Grande do Sul, Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Porto Alegre, Brazil
| | - Ricardo M Xavier
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Universidade Federal do Rio Grande do Sul, Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Porto Alegre, Brazil
| | - Gilda A Ferreira
- Programa de Pós-graduação em Ciências Aplicadas a Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Evaluating Risk: Benefit Ratio of Fat-Soluble Vitamin Supplementation to SARS-CoV-2-Infected Autoimmune and Cancer Patients: Do Vitamin–Drug Interactions Exist? Life (Basel) 2022; 12:life12101654. [PMID: 36295089 PMCID: PMC9604733 DOI: 10.3390/life12101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary This review brings attention to a crucial yet under-investigated subject which is vitamin–drug interactions. Fat-soluble vitamins such as vitamins A, D, E, and K have been proven to possess many beneficial effects in the treatment and prevention of COVID-19. Moreover, it has been reported that deficiencies of fat-soluble vitamins have been directly linked to COVID-19 infection-related morbidity and mortality, especially in high-risk populations such as cancer and autoimmune patients. However, many vitamin–drug interactions exist between most of the newly COVID-19 FDA-approved medications and fat-soluble vitamins. Hence, this mandates personalizing the COVID-19 treatment protocols, especially for patients who have any deficiency in any of these vital vitamins. Weighing the risk-to-benefit ratio of supplementing any of these fat-soluble vitamins with COVID-19 medications is considered crucial to maximize the therapeutic benefit and decrease the side effects of these drugs. Abstract COVID-19 is a recent pandemic that mandated the scientific society to provide effective evidence-based therapeutic approaches for the prevention and treatment for such a global threat, especially to those patients who hold a higher risk of infection and complications, such as patients with autoimmune diseases and cancer. Recent research has examined the role of various fat-soluble vitamins (vitamins A, D, E, and K) in reducing the severity of COVID-19 infection. Studies showed that deficiency in fat-soluble vitamins abrogates the immune system, thus rendering individuals more susceptible to COVID-19 infection. Moreover, another line of evidence showed that supplementation of fat-soluble vitamins during the course of infection enhances the viral clearance episode by promoting an adequate immune response. However, more thorough research is needed to define the adequate use of vitamin supplements in cancer and autoimmune patients infected with COVID-19. Moreover, it is crucial to highlight the vitamin–drug interactions of the COVID-19 therapeutic modalities and fat-soluble vitamins. With an emphasis on cancer and autoimmune patients, the current review aims to clarify the role of fat-soluble vitamins in SARS-CoV-2 infection and to estimate the risk-to-benefit ratio of a fat-soluble supplement administered to patients taking FDA-approved COVID-19 medications such as antivirals, anti-inflammatory, receptor blockers, and monoclonal antibodies.
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Bennett B, Tahir H, Ganguly S, Moorthy A. An update on the considerations for patients with rheumatic disease being treated with rituximab during the COVID-19 pandemic and the potential drug treatment strategies. Expert Opin Pharmacother 2022; 23:1695-1700. [PMID: 36180063 DOI: 10.1080/14656566.2022.2131395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Over the last two decades, rituximab has become an increasingly popular drug in the treatment of a wide range of rheumatic diseases. However, with the advent of the COVID-19 pandemic, clinicians face challenges in weighing risk against benefit in its use. AREAS COVERED A review of existing data was performed to examine the relationship between rituximab use, morbidity and mortality from COVID-19, and vaccine efficacy in patients with rheumatic diseases, aiming to guide clinicians in continued use of the medication and consider the direction of future research. A literature review was performed through a search of the PubMed database, using the terms ((SARS-CoV-2) OR (COVID-19)) AND (rituximab) AND (rheumatic), which generated an initial 55 results, with relevant articles then selected for inclusion. EXPERT OPINION In order to safeguard patients with an ongoing need for rituximab therapy, vaccination remains the primary concern. A target of performing booster doses 6 months after last rituximab dose is a reasonable estimate, which may be made more precise by use of B cell counts, although primary immunization should not be delayed. In those patients who remain seronegative, the use of newer antivirals and broadly neutralizing antibody infusions may help provide further safeguards.
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Affiliation(s)
- Benjamin Bennett
- Department of Rheumatology, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Hasan Tahir
- Department of Rheumatology, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK.,Division of Medicine, University College London, London, UK
| | - Sujata Ganguly
- University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | - Arumugam Moorthy
- University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
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Cardwell FS, Elliott SJ, Chin R, St Pierre Y, Choi MY, Urowitz MB, Ruiz-Irastorza G, Bernatsky S, Wallace DJ, Petri MA, Manzi S, Bae SC, Shin JM, Mak A, Cho J, Peschken CA, Ramsey-Goldman R, Fortin PR, Hanly JG, Pons-Estel BA, Nieto R, Askanase AD, Romero-Diaz J, Mosca M, Bruce IN, Rowbottom L, Mielczarek L, Tse K, Marion A, Cáhiz-González JC, Cattoni TG, Cornet A, Clarke AE. Health information use by patients with systemic lupus erythematosus (SLE) pre and during the COVID-19 pandemic. Lupus Sci Med 2022; 9:9/1/e000755. [PMID: 36283746 PMCID: PMC9606736 DOI: 10.1136/lupus-2022-000755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/12/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE We conducted an international survey of patients with SLE to assess their access, preference and trust in various health information sources pre-COVID-19 and during the COVID-19 pandemic. METHODS Patients with SLE were recruited from 18 observational cohorts, and patients self-reporting SLE were recruited through five advocacy organisations. Respondents completed an online survey from June 2020 to December 2021 regarding the sources of health information they accessed in the 12 months preceding (pre-11 March 2020) and during (post-11 March 2020) the pandemic. Multivariable logistic regressions assessed factors associated with accessing news and social media post-11 March 2020, and self-reporting negative impacts from health information accessed through these sources. RESULTS Surveys were completed by 2111 respondents; 92.8% were female, 76.6% had postsecondary education, mean (SD) age was 48.8 (14.0) years. Lupus specialists and family physicians were the most preferred sources pre-11 March 2020 and post-11 March 2020, yet were accessed less frequently (specialists: 78.5% pre vs 70.2% post, difference -8.3%, 95% CI -10.2% to -6.5%; family physicians: 57.1% pre vs 50.0% post, difference -7.1%, 95% CI -9.2% to -5.0%), while news (53.2% pre vs 62.1% post, difference 8.9%, 95% CI 6.7% to 11.0%) and social media (38.2% pre vs 40.6% post, difference 2.4%, 95% CI 0.7% to 4.2%) were accessed more frequently post-11 March 2020 vs pre-11 March 2020. 17.2% of respondents reported negative impacts from information accessed through news/social media. Those outside Canada, older respondents or with postsecondary education were more likely to access news media. Those in Asia, Latin America or younger respondents were more likely to access social media. Those in Asia, older respondents, males or with postsecondary education in Canada, Asia or the USA were less likely to be negatively impacted. CONCLUSIONS Physicians, the most preferred and trusted sources, were accessed less frequently, while news and social media, less trusted sources, were accessed more frequently post-11 March 2020 vs pre-11 March 2020. Increasing accessibility to physicians, in person and virtually, may help reduce the consequences of accessing misinformation/disinformation.
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Affiliation(s)
- Francesca S Cardwell
- Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Elliott
- Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Ricky Chin
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yvan St Pierre
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - May Y Choi
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Murray B Urowitz
- Schroeder Arthritis Institute, Kremblin Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, BioCruces Bizkaia Health Research Institute, University of the Basque Country, Barakaldo, Bizkaia, Spain
| | - Sasha Bernatsky
- Department of Medicine and Centre for Outcomes Research & Evaluation, McGill University, Montreal, Quebec, Canada
| | - Daniel J Wallace
- Rheumatology, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Jung-Min Shin
- Department of Rheumatology, Hanyang University, Seongdong-gu, Seoul, The Republic of Korea
| | - Anselm Mak
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore
| | - Jiacai Cho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Rheumatology, Department of Medicine, National University Hospital of Singapore, Singapore
| | - Christine A Peschken
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Paul R Fortin
- Medicine-Rheumatology, Centre Hospitalier de l'Université Laval, Quebec City, Quebec, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bernardo A Pons-Estel
- Rheumatology, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | - Romina Nieto
- Department of Rheumatology, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | | | - Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Leigha Rowbottom
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Karin Tse
- Lupus Foundation of America Inc, Washington, District of Columbia, USA
| | - Ashley Marion
- Lupus Foundation of America Inc, Washington, District of Columbia, USA
| | | | | | | | - Ann Elaine Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Truchetet ME, Drumez E, Barnetche T, Martin C, Devaux M, Goulenok T, Maria A, Schmidt J, Abdallah NA, Melki I, Hachulla E, Richez C. Outcome of COVID-19 in patients with rheumatic and inflammatory diseases treated with mycophenolic acid: data from the French RMD COVID-19 cohort. RMD Open 2022; 8:rmdopen-2022-002476. [PMID: 36113962 PMCID: PMC9485642 DOI: 10.1136/rmdopen-2022-002476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with inflammatory rheumatic and musculoskeletal diseases (iRMD) receiving mycophenolic acid (MPA) may have a less favourable outcome from COVID-19 infection. Our aim was to investigate whether MPA treatment is associated with severe infection and/or death. METHODS IRMD patients with and without MPA treatment with highly suspected/confirmed COVID-19 were included in this observational multicentre study. The primary outcome was death rate from COVID-19 with secondary objectives to determine the severity of infection and length of hospital stay. Outcome comparisons were made using regression models with and without adjustment on prespecified confounding factors. ORs, sub-HR (sHR) and 95% CIs were calculated using patients not treated with MPA as a reference group. RESULTS Of the 1977 patients, 1928 were not treated with MPA (393 were MPA eligible), and 49 patients were treated with MPA. MPA-treated patients had more severe disease, longer hospital stays and higher death rate from COVID-19 than non-MPA patients (OR 8.02 (95% CI 3.35 to 19.20), p<0.001; sHR 0.57 (95% CI 0.33 to 0.98), p=0.040; OR 11.58 (95% CI 4.10 to 32.69), p<0.001). In adjusted analyses, however, no outcome was independently associated with MPA treatment. Death rate, severity and length of hospital stay of MPA-treated patients were not significantly different from those of not treated but MPA-eligible patients. CONCLUSION MPA therapy is not associated with a more severe COVID-19 infection. However, due to increased vulnerability of developing a severe form of COVID-19, careful consideration should be taken with iRMD patients likely to be treated with MPA. TRIAL REGISTRATION NUMBER NCT04353609.
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Affiliation(s)
- Marie-Elise Truchetet
- Rheumatology Department, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, Aquitaine, France
| | - Elodie Drumez
- Department of Biostatistics, CHU Lille, Lille, Hauts-de-France, France
| | - Thomas Barnetche
- Rheumatology Department, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, Aquitaine, France
| | - Claire Martin
- Department of Biostatistics, CHU Lille, Lille, Hauts-de-France, France
| | - Mathilde Devaux
- Department of Internal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Saint-Germain-en-Laye, Île-de-France, France
| | - Tiphaine Goulenok
- Department of Internal Medicine, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Alexandre Maria
- Department of Internal Medicine, Saint-Eloi Hospital Department of Internal Medicine, Montpellier, Languedoc-Roussillon, France
| | - Jean Schmidt
- Department of Internal Medicine and RECIF, Amiens University Hospital, Amiens, France,Université de Picardie Jules Verne, Amiens, Hauts-de-France, France
| | - Nassim Ait Abdallah
- Unité de Médecine Interne (UF 04): CRMR MATHEC, Maladies auto-immunes et thérapie cellulaire; Centre de Référence des Maladies auto-immunes systémiques Rares d’Ile-de-France MATHEC, AP-HP, Hôpital St-Louis, Paris, France,IRSL, Recherche clinique appliquée à l'hématologie, EA3518 (Equipe 3 MATHEC-EUROCORD), Université de Paris, Paris, Île-de-France, France
| | - Isabelle Melki
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France,Department of General Paediatrics, Infectious Diseases and Internal Medicine, Hopital Universitaire Robert Debre, Paris, Île-de-France, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical immunology, Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France, Lille University School of Medicine, Lille, France
| | - Christophe Richez
- Rheumatology Department, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, Aquitaine, France
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Breakthrough SARS-CoV-2 infections, morbidity, and seroreactivity following initial COVID-19 vaccination series and additional dose in patients with SLE in New York City. THE LANCET RHEUMATOLOGY 2022; 4:e582-e585. [PMID: 35856060 PMCID: PMC9275793 DOI: 10.1016/s2665-9913(22)00190-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Yeoh SA, Gianfrancesco M, Lawson-Tovey S, Hyrich KL, Strangfeld A, Gossec L, Carmona L, Mateus EF, Schäfer M, Richez C, Hachulla E, Holmqvist M, Scirè CA, Lorenz HM, Voll RE, Hasseli R, Jayatilleke A, Hsu TYT, D'Silva KM, Pimentel-Quiroz VR, Vasquez Del Mercado M, Shinjo SK, Neto ETDR, Junior LFDR, de Oliveira E Silva Montandon AC, Pons-Estel GJ, Ornella S, D'Angelo Exeni ME, Velozo E, Jordan P, Sirotich E, Hausmann JS, Liew JW, Jacobsohn L, Gore-Massy M, Sufka P, Grainger R, Bhana S, Wallace Z, Robinson PC, Yazdany J, Machado PM. Factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. RMD Open 2022; 8:rmdopen-2022-002508. [PMID: 36100295 PMCID: PMC9471207 DOI: 10.1136/rmdopen-2022-002508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Su-Ann Yeoh
- Centre for Rheumatology, University College London, London, UK.,Department of Rheumatology, University College London University Hospitals NHS Foundation Trust, London, UK
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, University of Manchester, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Kimme L Hyrich
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK.,Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Anja Strangfeld
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France.,Department of Rheumatology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
| | - Martin Schäfer
- German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Berlin, Germany
| | - Christophe Richez
- Département de Rhumatologie, Referral Center for Rare Systemic Autoimmune Diseases RESO, CHU de Bordeaux, Bordeaux, France.,UMR CNRS 5164, Université de Bordeaux, Bordeaux, France
| | - Eric Hachulla
- Lille Inflammation Research International Center (LIRIC), University of Lille, Lille, France.,Département de Médecine Interne et Immunologie Clinique, Referral Center for Rare Systemic Autoimmune Diseases North and Northwest of France (CeRAINO), INSERM U995, CHU Lille, Lille, France
| | - Marie Holmqvist
- Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden
| | | | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany
| | - Rebecca Hasseli
- Department of Internal Medicine II, University Hospitals Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - Arundathi Jayatilleke
- Section of Rheumatology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Tiffany Y-T Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M D'Silva
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Victor R Pimentel-Quiroz
- Department of Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.,Universidad Cientifica del Sur, Lima, Peru
| | | | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Sofía Ornella
- Hospital Interzonal General de Agudos (HIGA) San Martin, La Plata, Buenos Aires, Argentina
| | | | - Edson Velozo
- Sanatorio y Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
| | | | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jonathan S Hausmann
- Program in Rheumatology, Boston Children's Hospital, Boston, MA, USA.,Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jean W Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Lindsay Jacobsohn
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | | | - Zachary Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, Australia.,Department of Rheumatology, Royal Brisbane and Woman's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Pedro M Machado
- Centre for Rheumatology, University College London, London, UK .,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.,National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Neuromuscular Diseases, University College London, London, UK
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Kirou KA, Dall`Era M, Aranow C, Anders HJ. Belimumab or anifrolumab for systemic lupus erythematosus? A risk-benefit assessment. Front Immunol 2022; 13:980079. [PMID: 36119023 PMCID: PMC9472122 DOI: 10.3389/fimmu.2022.980079] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023] Open
Abstract
Treatment of systemic lupus erythematosus (SLE) currently employs agents with relatively unselective immunosuppressive properties. However, two target-specific biological drugs have been approved: belimumab (anti-B-cell-activating factor/BAFF) and anifrolumab (anti-interferon alpha receptor-1/IFNAR1). Here, we performed a comparative risk-benefit assessment for both drugs based on the role of BAFF and IFNAR1 in host defense and the pathogenesis of SLE and by considering the available data on safety and efficacy. Due to differences in target expression sites, anti-IFNAR1, but not anti-BAFF, might elicit organ-specific effects, consistent with clinical efficacy data. The IFNAR1 is specifically involved in innate and adaptive antiviral immunity in most cells of the body. Consistent with this observation, the available safety data obtained from patients negatively selected for LN and neuropsychiatric SLE, primary immunodeficiencies, splenectomy and chronic HIV, HBV, HCV infections suggest an increased risk for some viral infections such as varicella zoster and perhaps influenza. In contrast, BAFF is mainly involved in adaptive immune responses in lymphoid tissues, thus anti-BAFF therapy modulates SLE activity and prevents SLE flares without interfering with local innate host defense mechanisms and should only marginally affect immune memory to previous pathogen exposures consistent with the available safety data from SLE patients without chronic HIV, HBV or HCV infections. When using belimumab and anifrolumab, careful patient stratification and specific precautions may minimize risks and maximize beneficial treatment effects for patients with SLE.
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Affiliation(s)
- Kyriakos A. Kirou
- Department of Medicine, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, United States
| | - Maria Dall`Era
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Cynthia Aranow
- Institute of Molecular Medicine, Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Hans-Joachim Anders
- Department of Medicine IV, University Hospital of the Ludwig Maximilian University, Munich, Germany
- *Correspondence: Hans-Joachim Anders,
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Mehta P, Gasparyan AY, Zimba O, Kitas GD. Systemic lupus erythematosus in the light of the COVID-19 pandemic: infection, vaccination, and impact on disease management. Clin Rheumatol 2022; 41:2893-2910. [PMID: 35639259 PMCID: PMC9152659 DOI: 10.1007/s10067-022-06227-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 02/07/2023]
Abstract
Patients with systemic lupus erythematosus (SLE) form a vulnerable group in terms of the impact of the COVID-19 pandemic on disease management. We conducted this overview by searches through Medline/PubMed, Scopus, and the Directory of Open Access Journals (DOAJ). The prevalence and severity of COVID-19, efficacy of COVID-19 vaccination, impact on the management of SLE, and the attitudes of SLE patients to COVID-19 and vaccination were explored. After screening and due exclusions, 198 studies were included for the final review. Patients with SLE have a greater risk of acquiring COVID-19 (0.6-22%) and related hospitalization (30%), severe disease (13.5%), and death (6.5%) than the general population. Older age, male gender, comorbidities, moderate or high disease activity, and glucocorticoid, rituximab, and cyclophosphamide use are associated with unfavorable outcomes, whereas methotrexate and belimumab use showed no association with outcomes. COVID-19 vaccines are safe in SLE with minimal risk of severe flares (< 2%). Vaccine efficacy is negatively associated with glucocorticoids. The overall attitude of patients towards vaccination is positive (54-90%). The pandemic has negatively affected access to medical care, hospitalizations, procurement of drugs, employment, and the mental health of patients which need to be addressed as part of holistic care in SLE. Key Points • Lupus patients are at a greater risk of acquiring COVID-19, related hospitalization, severe disease, and death than the general population. • COVID-19 vaccines are relatively safe for lupus patients with minimal risk of severe flares. • Lupus patients' attitude towards COVID-19 vaccination is predominantly positive.
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Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK.
| | - Olena Zimba
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - George D Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
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