Hospital admissions in inflammatory rheumatic diseases during the peak of COVID-19 pandemic: incidence and role of disease-modifying agents

  1. Benjamin Fernandez-Gutierrez
  2. Leticia Leon
  3. Alfredo Madrid
  4. Luis Rodriguez-Rodriguez
  5. Dalifer Freites
  6. Judit Font
  7. Arkaitz Mucientes
  8. Esther Culebras
  9. Jose Ignacio Colome
  10. Juan Angel Jover
  11. Lydia Abasolo

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Abstract

In this pandemic, it is essential for rheumatologists and patients to know the relationship between COVID-19 and inflammatory rheumatic diseases (IRDs). We wanted to assess the role of targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARDs) and other variables in the development of moderate-severe COVID-19 disease in IRD.

Methods:

An observational longitudinal study was conducted during the epidemic peak in Madrid (1 March to 15 April 2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid with a medical diagnosis of IRD were included. Main outcome: hospital admission related to COVID-19. Independent variable: ts/bDMARDs. Covariates: sociodemographic, comorbidities, type of IRD diagnosis, glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs), and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Incidence rate (IR) of hospital admission related to COVID-19 was expressed per 1000 patient-months. Cox multiple regression analysis was run to examine the influence of ts/bDMARDs and other covariates on IR of hospital admission related to COVID-19.

Results:

A total of 3951 IRD patients were included (5896 patient-months). Methotrexate was the csDMARD most used. Eight hundred and two patients were on ts/bDMARDs, mainly anti-TNF agents, and Rtx. Hospital admissions related to COVID-19 occurred in 54 patients (1.36%) with an IR of 9.15 (95% confidence interval: 7–11.9). In the multivariate analysis, older, male, comorbidities, and specific systemic autoimmune conditions (Sjögren, polychondritis, Raynaud, and mixed connective tissue disease) had more risk of hospital admissions. Exposition to ts/bDMARDs did not achieve statistical significance. Use of glucocorticoids, NSAIDs, and csDMARDs dropped from the final model.

Conclusion:

This study provides additional evidence in IRD patients regarding susceptibility to moderate–severe infection related to COVID-19.

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  1. Version published to 10.1177/1759720x20962692
  2. ScreenIT

    SciScore for 10.1101/2020.05.21.20108696: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practices and was approved by the HCSC institutional ethics committee (approval number 20/268-E_BS).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Another limitation is that we could have lost hospital admissions that have gone to other hospitals. Two of them were rescued for analysis, and we think there won’t be many more considering the state of alarm and confinement decreed in Spain since March 14. As strengths, we include 3,591 non-selected patients with a board spectrum of IRD, with not standardized immunosuppressive therapy reflecting clinical practice from our health area, being able to adjust for confounders. To our knowledge, this is the largest study to date outlining the severity of COVID-19 in terms of hospital admissions in IRD. It seems that patients with IRD could have a higher susceptibility of moderate-severe COVID-19 disease compared to the general population, maybe at expenses of systemic autoimmune diseases rather than chronic inflammatory arthritis. Moreover, we have been able to analyze in greater extent the safety surrounding the administration of disease modifying treatments. It seems that predisposition to develop moderate-severe COVID-19 disease in IRD, is at expenses of the type of diagnosis, age, sex and comorbidities, rather than the treatments exposed including ts/bDMARDs and csDMARDs.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.05.21.20108696v1 on medRxiv