High rates of severe COVID-19 in patients with vasculitis, polymyalgia rheumatica
medwireNews: An analysis of data from the COVID-19 Global Rheumatology Alliance and EULAR COVID-19 registries suggests high rates of severe COVID-19 among people with primary systemic vasculitis or polymyalgia rheumatica (PMR).
The study, which was reported at the ACR Convergence 2021 virtual meeting and published in The Lancet Rheumatology, included 1202 patients with one of these conditions who developed COVID-19 between March 2020 and April 2021. The most common diagnosis was PMR (31.1%), followed by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (29.4%), giant cell arteritis (15.2%), other vasculitis (15.0%), and Behçet’s syndrome (9.3%).
Sebastian Sattui (University of Pittsburgh, Pennsylvania, USA) and colleagues measured COVID-19 outcomes on an ordinal severity scale, finding “high rates” of severe outcomes in the study population. In all, 50.2% of the 1020 patients with available data did not require hospitalization, while 11.2% were hospitalized without supplemental oxygen, 23.4% required hospitalization with supplemental oxygen or ventilation, and 15.2% died.
The researchers note that rates of severe COVID-19 were particularly high in people with ANCA-associated vasculitis and those with giant cell arteritis. Mortality rates in these groups were 22.1% and 20.3%, respectively, and were lowest in people with Behçet’s syndrome, at 2.1%.
In accordance with the known risk factors for poor COVID-19 outcomes in the general population, older age (odds ratio [OR]=1.44 per each additional decade) and the presence of comorbidities (OR=1.39 for each additional comorbidity) were associated with a significantly elevated risk for worse COVID-19 outcomes on the ordinal scale.
Moreover, men had a significantly higher likelihood of experiencing worse COVID-19 outcomes than women (OR=1.38), as did people with moderate, high, or severe vasculitis or PMR disease activity (OR=2.12 vs remission) and those on glucocorticoids at a prednisolone-equivalent dose of at least 10 mg/day (OR=2.14 vs none). People included in the registry from October 2020 onwards had a significantly lower risk for poor COVID-19 outcomes than those included on or before June 15 in the same year.
Writing in an accompanying comment, Sara Monti (University of Pavia, Italy) says that the improvement in outcomes is reassuring, “implying a better management of COVID-19” over time, “and possibly the initial effect of the first patients receiving vaccination.”
Sattui et al also found that risk factors for severe COVID-19 “varied among different disease subtypes.” For instance, multivariable analysis showed that comorbidities were significant predictors among people with giant cell arteritis, but not those with ANCA-associated vasculitis or PMR, whereas taking glucocorticoids at a prednisolone-equivalent dose of 10 mg/day or higher was a significant predictor in those with giant cell arteritis or ANCA-associated vasculitis.
The commentator says that this study of people with vasculitis or PMR represents “the largest international cohort available to date,” and provides “important and highly needed insights to guide the management of these patients during the COVID-19 pandemic.”
“Additionally, this study emphasises the importance of multicentre, international efforts in the rheumatology community to gather valuable information on large cohorts of patients, even for rare forms of rheumatic disease,” she adds.
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