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  • OP0286 CHARACTERISTICS ASSOCIATED WITH SEVERE COVID-19 OUTCOMES IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE (COVID-19 GRA)

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Scientific Abstracts
Oral Presentations
New Developments in COVID-Research
OP0286 CHARACTERISTICS ASSOCIATED WITH SEVERE COVID-19 OUTCOMES IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE (COVID-19 GRA)
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  1. M. F. Ugarte-Gil1,2,
  2. G. S. Alarcon3,4,
  3. A. Seet5,
  4. Z. Izadi5,6,
  5. C. Reategui Sokolova2,7,
  6. A. E. Clarke8,
  7. L. Wise9,
  8. G. Pons-Estel10,
  9. M. J. Santos11,
  10. S. Bernatsky12,
  11. L. Mathias9,
  12. N. Lim9,
  13. J. Sparks13,
  14. Z. Wallace14,
  15. K. Hyrich15,
  16. A. Strangfeld16,
  17. L. Gossec17,
  18. L. Carmona18,
  19. E. Mateus19,
  20. S. Lawson-Tovey20,
  21. L. Trupin5,
  22. S. Rush5,
  23. G. Schmajuk5,
  24. P. Katz5,
  25. L. Jacobsohn5,
  26. S. Al Emadi21,
  27. E. Gilbert22,
  28. A. Duarte-Garcia23,
  29. M. Valenzuela-Almada24,
  30. T. Hsu25,
  31. K. D’silva26,
  32. N. Serling-Boyd27,
  33. P. Dieudé28,
  34. E. Nikiphorou29,
  35. V. Kronzer30,
  36. N. Singh31,
  37. B. Wallace32,
  38. A. Akpabio33,
  39. R. Thomas34,
  40. S. Bhana35,
  41. W. Costello36,
  42. R. Grainger37,
  43. J. Hausmann38,
  44. J. Liew39,
  45. E. Sirotich40,
  46. P. Sufka41,
  47. P. Robinson42,
  48. P. Machado43,
  49. M. Gianfrancesco5,
  50. J. Yazdany44
  51. on behalf of COVID-19 Global Rheumatology Alliance
  1. 1Universidad Científica del Sur, School of Medicine, Lima, Peru
  2. 2Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Rheumatology, Lima, Peru
  3. 3University of Alabama at Birmingham, Department of Medicine, Birmingham, Alabama, United States of America
  4. 4Universidad Peruana Cayetano Heredia, Facultad de Medicina, Lima, Peru
  5. 5University of California, Division of Rheumatology, Department of Medicine, San Francisco, United States of America
  6. 6University of California, Department of Epidemiology and Biostatistics, San Francisco, United States of America
  7. 7Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
  8. 8Cumming School of Medicine. University of Calgary, Division of Rheumatology Department of Medicine, Calgary, Canada
  9. 9University of Southern California, Division of Rheumatology, Department of Internal Medicine, Los Angeles, CA, United States of America
  10. 10Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
  11. 11Instituto de Medicina Molecular, Faculdade de Lisboa, Rheumatology Department, Hospital Garcia de Orta, Almada and Rheumatology Research Unit, Lisbon, Portugal
  12. 12McGill University Health Centre, Divisions of Rheumatology and Clinical Epidemiology, Quebec, Canada
  13. 13Brigham and Women’s Hospital and Harvard Medical School, Division of Rheumatology, Inflammation, and Immunity, Boston, MA, United States of America
  14. 14Massachusetts General Hospital, Harvard Medical School, Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Boston, MA, United States of America
  15. 15The University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, United Kingdom
  16. 16German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Care Research, Berlin, Germany
  17. 17Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
  18. 18Instituto de Salud Musculoesquelética, Instituto de Salud Musculoesquelética, Madrid, Spain
  19. 19Portuguese League Against Rheumatic Diseases (LPCDR), Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
  20. 20University of Manchester, Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester, United Kingdom
  21. 21Hamad Medical Corporation, Rheumatology Department, Doha, Qatar
  22. 22Mayo Clinic, Division of Rheumatology, Jacksonville, Florida, United States of America
  23. 23Mayo Clinic, Division of Rheumatology and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, United States of America
  24. 24Mayo Clinic, Division of Rheumatology, Rochester, Minnesota, United States of America
  25. 25righam and Women’s Hospital and Harvard Medical School, Division of Rheumatology, Inflammation, and Immunity, Boston, United States of America
  26. 26Massachusetts General Hospital, Harvard Medical School, Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Boston, United States of America
  27. 27Massachusetts General Hospital, Harvard Medical School, Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Boston, United States of America
  28. 28Hôpital Bichat, Rheumatology, Paris, France
  29. 29Kings College London, Centre for Rheumatic Disease, London, United Kingdom
  30. 30Mayo Clinic, Rheumatology, Rochester, United States of America
  31. 31University of Washington, Division of Rheumatology, Washington, United States of America
  32. 32University of Michigan, Department of Internal Medicine/Rheumatology, Michigan, United States of America
  33. 33University of Uno Teaching Hospital, Rheumatology, Uyo, Nigeria
  34. 34University of Queensland, UQ Diamantina Institute, Brisbane, Australia
  35. 35Crystal Run Health, Crystal Run Health, Middletown, NY, United States of America
  36. 36Irish Children’s Arthritis Network (iCAN), Irish Children’s Arthritis Network (iCAN), Ireland
  37. 37University of Otago, Department of Medicine, Wellington, New Zealand
  38. 38Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Rheumatology, Boston Children’s Hospital; Division of Rheumatology and Clinical Immunology, Boston, MA, United States of America
  39. 39Boston University School of Medicine, Section of Rheumatology, Department of Medicine, Boston, United States of America
  40. 40McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, ON, Canada
  41. 41Healthpartners, St. Paul, MN, United States of America
  42. 42University of Queensland, Faculty of Medicine, Brisbane, United States of America
  43. 43University College London, Centre for Rheumatology & Department of Neuromuscular Diseases, London, United Kingdom
  44. 44University of California, Division of Rheumatology, Department of Medicine, San Francisco, United States of America

Abstract

Background: An increased risk of severe COVID-19 outcomes may be seen in patients with autoimmune diseases on moderate to high daily doses of glucocorticoids, as well as in those with comorbidities. However, specific information about COVID-19 outcomes in SLE is scarce.

Objectives: To determine the characteristics associated with severe COVID-19 outcomes in a multi-national cross-sectional registry of COVID-19 patients with SLE.

Methods: SLE adult patients from a physician-reported registry of the COVID-19 GRA were studied. Variables collected at COVID-19 diagnosis included age, sex, race/ethnicity, region, comorbidities, disease activity, time period of COVID-19 diagnosis, glucocorticoid (GC) dose, and immunomodulatory therapy. Immunomodulatory therapy was categorized as: antimalarials only, no SLE therapy, traditional immunosuppressive (IS) drug monotherapy, biologics/targeted synthetic IS drug monotherapy, and biologic and traditional IS drug combination therapy. We used an ordinal COVID-19 severity outcome defined as: not hospitalized/hospitalized without supplementary oxygen; hospitalized with non-invasive ventilation; hospitalized with mechanical ventilation/extracorporeal membrane oxygenation; and death. An ordinal logistic regression model was constructed to assess the association between demographic characteristics, comorbidities, medications, disease activity and COVID-19 severity. This assumed that the relationship between each pair of outcome groups is of the same direction and magnitude.

Results: Of 1069 SLE patients included, 1047 (89.6%) were female, with a mean age of 44.5 (SD: 14.1) years. Patient outcomes included 815 (78.8%) not hospitalized/hospitalized without supplementary oxygen; 116 (11.2) hospitalized with non-invasive ventilation, 25 (2.4%) hospitalized with mechanical ventilation/extracorporeal membrane oxygenation and 78 (7.5%) died. In a multivariate model (n=804), increased age [OR=1.03 (1.01, 1.04)], male sex [OR =1.93 (1.21, 3.08)], COVID-19 diagnosis between June 2020 and January 2021 (OR =1.87 (1.17, 3.00)), no IS drug use [OR =2.29 (1.34, 3.91)], chronic renal disease [OR =2.34 (1.48, 3.70)], cardiovascular disease [OR =1.93 (1.34, 3.91)] and moderate/high disease activity [OR =2.24 (1.46, 3.43)] were associated with more severe COVID-19 outcomes. Compared with no use of GC, patients using GC had a higher odds of poor outcome: 0-5 mg/d, OR =1.98 (1.33, 2.96); 5-10 mg/d, OR =2.88 (1.27, 6.56); >10 mg/d, OR =2.01 (1.26, 3.21) (Table 1).

View this table:
Table 1.

Characteristics associated with more severe COVID-19 outcomes in SLE. (N=804)

Conclusion: Increased age, male sex, glucocorticoid use, chronic renal disease, cardiovascular disease and moderate/high disease activity at time of COVID-19 diagnosis were associated with more severe COVID-19 outcomes in SLE. Potential limitations include possible selection bias (physician reporting), the cross-sectional nature of the data, and the assumptions underlying the outcomes modelling.

Acknowledgements: The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the ACR, EULAR) the UK National Health Service, the National Institute for Health Research (NIHR), or the UK Department of Health, or any other organization.

Disclosure of Interests: Manuel F. Ugarte-Gil Grant/research support from: Pfizer, Janssen, Graciela S Alarcon: None declared, Andrea Seet: None declared, Zara Izadi: None declared, Cristina Reategui Sokolova: None declared, Ann E Clarke Consultant of: AstraZeneca, BristolMyersSquibb, GlaxoSmithKline, Exagen Diagnostics, Leanna Wise: None declared, Guillermo Pons-Estel: None declared, Maria Jose Santos: None declared, Sasha Bernatsky: None declared, Lauren Mathias: None declared, Nathan Lim: None declared, Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum unrelated to this work., Grant/research support from: Amgen and Bristol-Myers Squibb, Zachary Wallace Consultant of: Viela Bio and MedPace, Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi, Kimme Hyrich Speakers bureau: Abbvie, Grant/research support from: MS, UCB, and Pfizer, Anja Strangfeld Speakers bureau: AbbVie, MSD, Roche, BMS, Pfizer, Grant/research support from: AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB, Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, Grant/research support from: Lilly, Mylan, Pfizer, Loreto Carmona: None declared, Elsa Mateus Grant/research support from: Pfizer, Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA, Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Patti Katz: None declared, Lindsay Jacobsohn: None declared, Samar Al Emadi: None declared, Emily Gilbert: None declared, Ali Duarte-Garcia: None declared, Maria Valenzuela-Almada: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Philippe Dieudé Consultant of: Boerhinger Ingelheim, Bristol-Myers Squibb, Lilly, Sanofi, Pfizer, Chugai, Roche, Janssen unrelated to this work, Grant/research support from: Bristol-Myers Squibb, Chugaii, Pfizer, unrelated to this work, Elena Nikiphorou: None declared, Vanessa Kronzer: None declared, Namrata Singh: None declared, Beth Wallace: None declared, Akpabio Akpabio: None declared, Ranjeny Thomas: None declared, Suleman Bhana Consultant of: AbbVie, Horizon, Novartis, and Pfizer (all <$10,000) unrelated to this work, Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones, Jonathan Hausmann Consultant of: Novartis, Sobi, Biogen, all unrelated to this work (<$10,000), Jean Liew Grant/research support from: Pfizer outside the submitted work, Emily Sirotich Grant/research support from: Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer based organization whose activities are largely supported by independent grants from pharmaceutical companies, Paul Sufka: None declared, Philip Robinson Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000), Milena Gianfrancesco: None declared, Jinoos Yazdany Consultant of: Eli Lilly and AstraZeneca unrelated to this project

https://doi.org/10.1136/annrheumdis-2021-eular.2984

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