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

• Main Authors: Valderílio Feijó Azevedo, Sueli Carneiro, Ana Karla G Melo, Claudia Diniz Lopes Marques, Adriana Maria Kakehasi, Marcelo Medeiros Pinheiro, Licia Maria Henrique Mota, Cleandro Pires Albuquerque, Carolina Rocha Silva, Gabriela Porfirio Jardim Santos, Edgard Torres Reis-Neto, Pedro Matos, Guilherme Devide, Andrea Dantas, Rina Dalva Giorgi, Adriana de Oliveira Marinho, Lilian David Azevedo Valadares, Gilda Aparecida Ferreira, Flavia Patricia de Sena Santos, Nicole Pamplona Bueno Andrade, Michel Alexandre Yazbek, Eduardo S Paiva, Ana Beatriz Santos Bacchiega de Freitas, José Roberto Provenza, Ricardo Acayaba de Toledo, Sheilla Fontenelle, Gecilmara Cristina Salviato Pileggi, Ana Paula Monteiro Gomides Reis, Felipe Omura
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2021-04-01
• Series: RMD Open
• Online Access: https://rmdopen.bmj.com/content/7/1/e001461.full

Objectives To 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.Methods Analysis 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.Results 334 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).Conclusions Age >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.