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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 Rosenbaum et al
  1. Kimme L Hyrich1,2,
  2. Martin Schäfer3,
  3. Anja Strangfeld3,
  4. Loreto Carmona4,
  5. Laure Gossec5,6,
  6. Elsa F Mateus7,8,
  7. Saskia Lawson-Tovey1,2,
  8. Milena Gianfrancesco9,
  9. Philip C Robinson10,11,
  10. Jinoos Yazdany9,
  11. Pedro M Machado12,13,14
  1. 1Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK
  2. 2National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
  3. 3Epidemiology and Health Care Research, German Rheumatism Research Center Berlin (DRFZ Berlin), Berlin, Germany
  4. 4Instituto de Salud Musculoesquelética, Madrid, Spain
  5. 5Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France
  6. 6Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP.Sorbonne Université, Paris, France
  7. 7Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
  8. 8Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), European Alliance of Associations for Rheumatology (EULAR), Kilchberg, Switzerland
  9. 9Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
  10. 10Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  11. 11Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital Health Service District, Brisbane, Queensland, Australia
  12. 12Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
  13. 13National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
  14. 14Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Pedro M Machado, Centre for Rheumatology, University College London, London, UK; p.machado{at}

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We thank Rosenbaum et al1 for their correspondence on our article.2 In their reply, they largely report updated results of COVID-19 occurrence and subjective patient-reported COVID-19 severity from their patient survey of adult patients with spondyloarthritis and specifically comment that in their analysis, sulfasalazine did not ‘increase the risk to develop COVID-19’, nor did it increase the severity of those who were infected. Unfortunately, no details of the statistical methods, including any additional statistical adjustments (eg, age, sex, comorbidities and disease activity) or details of missing data, were included, and only a point estimate of risk was provided for each therapy without CIs, only p values, which therefore limits interpretation. While it is important to share reports of outcomes of COVID-19 among our populations of patients with rheumatic and musculoskeletal diseases (RMDs), it must be pointed out that the survey presented, as well as the subsequent analysis, is fundamentally different from our report on COVID-19-related mortality set within the Global Rheumatology Alliance (GRA) provider database and therefore the two outputs should not be compared, either directly or indirectly.

First, the GRA database is based on physician reports of COVID-19 among patients with known rheumatic disease and therefore can only be used to look at the associations between demographic and clinical features and COVID-19 outcomes among those known to have COVID-19. The data cannot be used to look at factors associated with acquisition of SARS-CoV-2 infection or development of COVID-19 disease, which is the focus of the report presented in the correspondence. These factors should not be compared since restricting the analysis to patients with an existing COVID-19 diagnosis may cause relationships between any variables that relate to COVID-19 acquisition to be distorted compared with a more general population, due to collider bias.3 Indeed, factors associated with …

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  • Handling editor Josef S Smolen

  • Twitter @carmona_loreto, @saskiaamber, @philipcrobinson, @pedrommcmachado

  • Collaborators No applicable.

  • Contributors KLH and 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.

  • Competing interests 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 Biomedical Research Centre. MS has nothing to disclose. AS reports personal fees from lectures for AbbVie, MSD, Roche, BMS and Pfizer, all 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. LG reports personal consultant fees from AbbVie, Amgen, BMS, Biogen, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis and UCB, and grants from Amgen, Lilly, Janssen, Pfizer, Sandoz, Sanofi and Galapagos, all unrelated to this manuscript. 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, and GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work. SL-T has nothing to disclose. MG reports grants from National Institutes of Health, NIAMS, outside the submitted work. 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. 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, University College London Hospitals and Biomedical Research Centre.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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