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

• Published in: Rheumatic & musculoskeletal diseases open Vol. 7; no. 1; p. e001461
• Main Authors: Marques, Claudia Diniz Lopes, Kakehasi, Adriana Maria, Pinheiro, Marcelo Medeiros, Mota, Licia Maria Henrique, Albuquerque, Cleandro Pires, Silva, Carolina Rocha, Santos, Gabriela Porfirio Jardim, Reis-Neto, Edgard Torres, Matos, Pedro, Devide, Guilherme, Dantas, Andrea, Giorgi, Rina Dalva, Omura, Felipe, Marinho, Adriana de Oliveira, Valadares, Lilian David Azevedo, Melo, Ana Karla G, Ribeiro, Francinne Machado, Ferreira, Gilda Aparecida, Santos, Flavia Patricia de Sena, Ribeiro, Sandra Lucia Euzebio, Andrade, Nicole Pamplona Bueno, Yazbek, Michel Alexandre, Souza, Viviane Angelina de, Paiva, Eduardo S, Azevedo, Valderilio Feijo, Freitas, Ana Beatriz Santos Bacchiega de, Provenza, José Roberto, Toledo, Ricardo Acayaba de, Fontenelle, Sheilla, Carneiro, Sueli, Xavier, Ricardo, Pileggi, Gecilmara Cristina Salviato, Reis, Ana Paula Monteiro Gomides
• Format: Journal Article
• Language: English
• Published: England EULAR 01.01.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; Age; autoimmune diseases; Brazil - epidemiology; Coronaviruses; COVID-19; COVID-19 - immunology; COVID-19 - mortality; COVID-19 - therapy; Critical Care - statistics & numerical data; Diabetes; Disease; Emergency medical care; Emergency Medical Services - statistics & numerical data; epidemiology; Female; health care; Hospitalization - statistics & numerical data; Humans; Hypertension; Immunosuppression - adverse effects; Infections; Intensive care; Lupus; Male; Middle Aged; outcome and process assessment; outcome assessment; Pandemics; Prospective Studies; Registries; Respiration, Artificial - statistics & numerical data; Rheumatic diseases; Rheumatic Diseases - complications; Rheumatic Diseases - immunology; Rheumatoid arthritis; Severe acute respiratory syndrome coronavirus 2; Social isolation; therapeutics; Tumor necrosis factor-TNF; Ventilators; Brazil; autoimmune diseases; epidemiology; therapeutics; outcome assessment; outcome and process assessment; health care
• ISSN: 2056-5933; 2056-5933
• DOI: 10.1136/rmdopen-2020-001461

ObjectivesTo evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19.MethodsAnalysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study.Results334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018).ConclusionsAge >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.