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We read with interest the recent report by Mathian et al 1 regarding the clinical course of COVID-19 infection in 17 patients with systemic lupus erythematosus (SLE) under long-term hydroxychloroquine treatment. We report supportive findings in five patients with SLE, contextualised in a larger cohort of patients with rheumatological conditions, from an academic, tertiary-care population.
Between 1 March and 20 April 2020, 31 patients followed at University of Michigan rheumatology clinics were diagnosed with COVID-19 (see online supplementary table 1). Five (16%) of these patients had SLE, four of whom were taking hydroxychloroquine with a median (range) duration of 7 (6–8) years. Compared with the overall cohort, patients with SLE appear more likely to be of black race (80% vs 42%), obese (80% vs 65%), have chronic obstructive pulmonary disease or asthma (60% vs 35%), use glucocorticoid therapy (80% vs 39%) and have a history of tobacco exposure (80% vs 45%).
Four patients with SLE (80%) were hospitalised for COVID-19; three (60%) required invasive ventilation; and one (20%) died of the disease. In the overall cohort, 20 (64%) were hospitalised; 6 (19%) required invasive ventilation; and 4 (13%) died. Among those patients with SLE, the median (range) SLE duration was 13 (9–36) years. At COVID-19 diagnosis, all four patients with SLE who were hospitalised with COVID-19 were in remission (Systemic Lupus Erythematosus Disease Activity Index score<3). The remaining patient, who had a mild COVID-19 course, had no laboratory evaluation when symptomatic.
In summary, our experience suggests that patients with SLE may develop more severe manifestations of COVID-19 infection, even relative to patients with other autoimmune diseases. Like Mathian et al , our SLE population had clinically quiescent lupus and long-term hydroxychloroquine exposure. Black race, respiratory comorbidities, and glucocorticoid and tobacco exposure were common in our cohort, and higher rates of these predisposing factors among patients with SLE may help explain the higher rate of severe disease from COVID-19.
Twitter @BethIWallace, @Kahlenberglab
Contributors All authors drafted and edited 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.
Competing interests JMK reports personal fees from AstraZeneca, personal fees from Eli Lilly, personal fees from Boehringer Ingleheim, and grants and personal fees from Bristol Myers Squibb, during the conduct of the study. No other authors have any competing interests to disclose.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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