TY - JOUR
T1 - Impact of Risk Factors on COVID-19 Outcomes in Unvaccinated People With Rheumatic Diseases
T2 - A Comparative Analysis of Pandemic Epochs Using the COVID-19 Global Rheumatology Alliance Registry
AU - Yazdany, Jinoos
AU - Ware, Anna
AU - Wallace, Zachary S.
AU - Bhana, Suleman
AU - Grainger, Rebecca
AU - Hachulla, Eric
AU - Richez, Christophe
AU - Cacoub, Patrice
AU - Hausmann, Jonathan S.
AU - Liew, Jean W.
AU - Sirotich, Emily
AU - Jacobsohn, Lindsay
AU - Strangfeld, Anja
AU - Mateus, Elsa F.
AU - Hyrich, Kimme L.
AU - Gossec, Laure
AU - Carmona, Loreto
AU - Lawson-Tovey, Saskia
AU - Kearsley-Fleet, Lianne
AU - Schaefer, Martin
AU - Ribeiro, Sandra Lucia Euzebio
AU - Al-Emadi, Samar
AU - Hasseli, Rebecca
AU - Müller-Ladner, Ulf
AU - Specker, Christof
AU - Schulze-Koops, Hendrik
AU - Bernardes, Miguel
AU - Fraga, Vanessa Machado
AU - Rodrigues, Ana Maria
AU - Sparks, Jeffrey A.
AU - Ljung, Lotta
AU - Di Giuseppe, Daniela
AU - Tidblad, Liselotte
AU - Wise, Leanna
AU - Duarte-García, Alí
AU - Ugarte-Gil, Manuel F.
AU - Colunga-Pedraza, Iris Jazmín
AU - Martínez-Martínez, Marco Ulises
AU - Alpizar-Rodriguez, Deshire
AU - Xavier, Ricardo Machado
AU - Isnardi, Carolina A.
AU - Pera, Mariana
AU - Pons-Estel, Guillermo
AU - Izadi, Zara
AU - Gianfrancesco, Milena A.
AU - Carrara, Greta
AU - Scirè, Carlo Alberto
AU - Zanetti, Anna
AU - Machado, Pedro M.
N1 - Publisher Copyright:
© 2023 American College of Rheumatology.
PY - 2024/2
Y1 - 2024/2
N2 - Objective: Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern. Methods: Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates. The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types. Results: Among 19,256 unvaccinated people with RDs and COVID-19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B-cell–depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B-cell–depleting therapy was associated with worse outcomes. Conclusion: Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study.
AB - Objective: Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern. Methods: Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates. The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types. Results: Among 19,256 unvaccinated people with RDs and COVID-19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B-cell–depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B-cell–depleting therapy was associated with worse outcomes. Conclusion: Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study.
UR - http://www.scopus.com/inward/record.url?scp=85176146594&partnerID=8YFLogxK
U2 - 10.1002/acr.25220
DO - 10.1002/acr.25220
M3 - Artículo
C2 - 37643903
AN - SCOPUS:85176146594
SN - 2151-464X
VL - 76
SP - 274
EP - 287
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 2
ER -
