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Response to: ‘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’ by Arnaud and Devilliers
  1. Pedro M Machado1,2,3,
  2. Martin Schäfer4,
  3. Anja Strangfeld4,
  4. Laure Gossec5,6,
  5. Milena Gianfrancesco7,
  6. Saskia Lawson-Tovey8,9,
  7. Elsa F Mateus10,11,
  8. Loreto Carmona12,
  9. Kimme L Hyrich8,9,
  10. Philip C Robinson13,14,
  11. Jinoos Yazdany7
  1. 1 Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK
  2. 2 National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), University College London Hospitals (UCLH) NHS Foundation Trust, London, UK
  3. 3 Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
  4. 4 Epidemiology and Health Care Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
  5. 5 Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
  6. 6 Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP.Sorbonne Université, Paris, France
  7. 7 Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
  8. 8 Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
  9. 9 National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
  10. 10 Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), European Alliance of Associations for Rheumatology (EULAR), Kilchberg, Switzerland
  11. 11 Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
  12. 12 Instituto de Salud Musculoesquelética, Madrid, Spain
  13. 13 Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
  14. 14 Royal Brisbane & Women’s Hospital, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
  1. Correspondence to Dr Pedro M Machado, Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London WC1E 6JF, UK; p.machado{at}

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We thank Arnaud and Devilliers1 for their correspondence on our article.2 They raise the important topic of risk prediction models for estimating the risk of COVID-19-related death, and the potential development of a risk prediction tool using data from our article.

We agree with the authors that patients using immunosuppressive/immunomodulatory agents have different risks, depending on factors such as their age, chronic conditions and specific drug therapies. However, we also recognise that there are significant limitations in using the estimates published in our manuscript to develop a COVID-19-related death risk prediction model to guide vaccination strategies. These limitations include:

  1. While robust models that predict the prognosis of COVID-19 are desirable to support decisions about shielding, hospital admission, treatment and population level interventions such as COVID-19 vaccination, this was not the primary aim of the published study. Importantly, it should be noted that owing to the voluntary nature of the registry there is an inherent selection bias, with an over-representation of severe cases, as discussed in our manuscript. Any model developed in a specific dataset will only reflect the risk for a particular patient under similar circumstances and receiving similar care. Therefore, in the same way that the hospitalisation and death rates reported in our article cannot be extrapolated to the entire population of patients with rheumatic diseases, a risk model developed using …

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  • Handling editor Josef S Smolen

  • Twitter @pedrommcmachado, @carmona_loreto, @philipcrobinson

  • Contributors PMM drafted the first version of the manuscript. All authors revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer 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 American College of Rheumatology, the European Alliance of Associations for Rheumatology, the (UK) National Health Service, the National Institute for Health Research, or the (UK) Department of Health, or any other organisation.

  • Competing interests PMM has received consulting/speaker’s fees from AbbVie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, and is supported by the National Institute for Health Research (NIHR), University College London Hospitals, Biomedical Research Centre (BRC). MS has nothing to disclose. AS reports personal fees from lectures for AbbVie, MSD, Roche, BMS and Pfizer, all outside the submitted work. LG reports personal consultant fees from AbbVie, Amgen, BMS, Biogen, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, UCB, and grants from Amgen, Lilly, Janssen, Pfizer, Sandoz, Sanofi, Galapagos, all unrelated to this manuscript. MAG reports grants from National Institutes of Health, NIAMS, outside the submitted work. SLT has nothing to disclose. SLT has nothing to disclose. EFM reports that LPCDR received support for specific activities: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work. LC has not received fees or personal grants from any laboratory, but her institute works by contract for laboratories among other institutions, such as AbbVie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, S.A., Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH, and UCB Pharma. KLH reports she has received non-personal speaker’s fees from AbbVie and grant income from BMS, UCB, and Pfizer, all unrelated to this manuscript, and is supported by the NIHR Manchester BRC. PCR reports personal fees from AbbVie, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Roche and UCB, non-financial support from BMS, research funding from Janssen, Novartis, Pfizer and UCB, all outside the submitted work.JY reports consulting fees from Astra Zeneca and Eli Lilly, and grants from Pfizer, outside the submitted work.

  • 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 Commissioned; internally peer reviewed.

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