Article Text
PDF
Abstract
Objectives To investigate temporal trends in incidence and severity of COVID-19 among patients with systemic autoimmune rheumatic diseases (SARDs) from the first wave through the initial Omicron wave.
Methods We conducted a retrospective cohort study investigating COVID-19 outcomes among patientswith SARD systematically identified to have confirmed COVID-19 from 1 March 2020 to 31 January 2022 at Mass General Brigham. We tabulated COVID-19 counts of total and severe cases (hospitalisations or deaths) and compared the proportion with severe COVID-19 by calendar period and by vaccination status. We used logistic regression to estimate the ORs for severe COVID-19 for each period compared with the early COVID-19 period (reference group).
Results We identified 1449 patients with SARD with COVID-19 (mean age 58.4 years, 75.2% female, 33.9% rheumatoid arthritis). There were 399 (28%) cases of severe COVID-19. The proportion of severe COVID-19 outcomes declined over calendar time (p for trend <0.001); 46% of cases were severe in the early COVID-19 period (1 March 2020–30 June 2020) vs 15% in the initial Omicron wave (17 December 2021–31 January 2022; adjusted OR 0.29, 95% CI 0.19 to 0.43). A higher proportion of those unvaccinated were severe compared with not severe cases (78% vs 60%).
Conclusions The proportion of patients with SARD with severe COVID-19 has diminished since early in the pandemic, particularly during the most recent time periods, including the initial Omicron wave. Advances in prevention, diagnosis and treatment of COVID-19 may have improved outcomes among patients with SARD.
- Autoimmune Diseases
- Covid-19
- Vaccination
Data availability statement
Data are available on reasonable request. This study includes patient data from Mass General Brigham. The data that support the findings of this study may be made available upon reasonable request by contacting the corresponding author, JAS.
This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
https://bmj.com/coronavirus/usageStatistics from Altmetric.com
Data availability statement
Data are available on reasonable request. This study includes patient data from Mass General Brigham. The data that support the findings of this study may be made available upon reasonable request by contacting the corresponding author, JAS.
Footnotes
ZSW and JAS are joint senior authors.
Handling editor Josef S Smolen
Twitter @zach_wallace_md, @jeffsparks
ZSW and JAS contributed equally.
Contributors YK, NJP, ZSW and JAS designed the study, were responsible for the acquisition, analysis and interpretation of data, and drafted and revised the article. XW was involved in the analysis and interpretation of the data. CC, KV, EK, EPB, GQ, MD, TY-TH, MEW and DT were involved in the data acquisition, interpretation, and revision of the manuscript. JAS and ZSW are joint senior authors. All authors approved the final version of the article. JAS accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.
Funding YK and TY-TH are supported by the National Institutes of Health Ruth L. Kirschstein Institutional National Research Service Award (T32 AR007530). NJP is supported by the Rheumatology Research Foundation Scientist Development Award. ZSW is funded by NIH/NIAMS (K23 AR073334 and R03 AR078938). JAS is funded by NIH/NIAMS (grant numbers R01 AR077607, P30 AR070253, and P30 AR072577), the R. Bruce and Joan M. Mickey Research Scholar Fund, and the Llura Gund Award for Rheumatoid Arthritis Research and Care.
Competing interests NJP reports consulting fees from FVC Health unrelated to this work. MEW reports research support from Bristol Meyers Squibb, Sanofi, Eli Lilly, Amgen, and consulting fees from Abbvie, Aclaris, Amgen Bristol Myers Squibb, Corevitas, EQRx, Genosco, GlaxoSmithKline, Gilead, Horizon, Johnson & Johnson, Eli Lilly, Pfizer, Roche, Sanofi, Scipher, Set Point, and Tremeau, and stock options in Can-Fite, Inmediz, and Scipher unrelated to this work. ZSW reports research support from Bristol-Myers Squibb and Principia/Sanofi and consulting fees from Viela Bio, Zenas BioPharma, and MedPace. JAS reports research support from Bristol Myers Squibb and consultancy fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum and Pfizer unrelated to this work. All other authors report no competing interests.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.