OUTCOMES OF COVID-19 INFECTION IN PATIENTS WITH PRIMARY SYSTEMIC VASCULITIS AND POLYMYALGIA RHEUMATICA: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN REGISTRY
Authors: Sebastian Sattui et al.
Primary Systemic Vasculitis (PSV) including ANCA vasculitis (AAV), giant cell arteritis (GCA), Behçet’s syndrome, and other vasculitides and PMR cases from the COVID-19 Global Rheumatology Alliance registries (12/Mar/2020-12/Apr/2021) were analyzed. The COVID-19 severity outcome was: 1) no hospitalization, 2) hospitalization without oxygen, 3) hospitalization with oxygen/ventilation, or 4) death. Relevant covariates included age, sex, race, season, number of comorbidities, BMI, smoking status, disease activity, immunosuppressive therapies, glucocorticoid (GC), and region.
Of 1,202 patients, 61.0% were female; mean age was 63.8 years. Diagnoses: PMR (31.1%), AAV (29.3%), GCA (15.2%), Behçet’s syndrome (9.4%), and other vasculitis (15.0%). 508 (49.8%) patients were hospitalized, and 155 (15.2%) patients died. Older age, male sex, GC dose ≥ 10 mg/day, moderate/severe or high disease activity and number of comorbidities were associated with worse outcome. Overall, severe outcomes were less likely if COVID-19 infection developed between October 1, 2020, and April 12, 2021.
In the disease-specific stratified analysis, 20.3% and 22.2% of patients with GCA and AAV, respectively, died. Risk factors for poorer outcomes in GCA were: older age and obesity; in AAV: older age, rituximab or cyclophosphamide use, and moderate/severe or high disease activity; in PMR: older age, higher comorbidity burden.
Patients with GCA or AAV who had COVID-19 infection had higher rates of severe outcomes compared to PMR and other vasculitis, even despite similar ages of the GCA and PMR groups. It is noteworthy that both, rituximab and cyclophosphamide treatment resulted in bad outcome. This is likely explained by more severe disease manifestations necessitating a profound immune suppression. (It contrasts to recommendations about COVID vaccination. By the ACR rituximab but not cyclophosphamide is listed as having a strong negative effect.)