Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry
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  • Published on:
    Correspondence on "Factors associated with COVID-19–related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry"
    • Manuel Baturone, Rheumatologist CEAL private rheumatology unit. Sevilla, Andalucía, ES
    • Other Contributors:
      • Caridad Perez Sumariva, Rheumatologist
      • Francisco Gallo, Rheumatologish

    Strangfeld et al (1) recently reported on the association between death of patients affected by inflammatory rheumatic diseases and COVID-19 and a series of factors, the most notable of which were advanced age, specific comorbid conditions, and, surprisingly, sulfasalazine. This finding differed from those for other drugs in the overall model and in all the subgroups, with an odds ratio that was only exceeded by
    that of rituximab. However, the finding only applied to those with a current or previous history of smoking.
    While we should not attribute causality to the association between sulfasalazine and COVID-19–related death, and despite the limitations arising from selection bias due to the voluntary nature of the registry in the study under discussion, we need to find an explanation for this association, especially given the coincidence with another series discussed by Strangefeld et al (1), where COVID-19 was more severe in patients treated with sulfasalazine or its metabolite 5-ASA for inflammatory bowel disease.
    In their attempt to provide an explanation for their findings, the authors state that the choice of sulfasalazine over other DMARDs in groups of patients who are affected by more comorbid conditions and are therefore more likely to die is a confounding factor. However, this does not explain the findings in the series of patients with inflammatory bowel disease the authors themselves comment on.
    We believe there may be a reason for this...

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    Conflict of Interest:
    None declared.