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Altuwairqi A, Ali AH, Alariefy AA, Bahlas S, AlZahrani SK, Zarei EW, Alshaikh AE, Khan AH, Attar AA. Assessment of COVID-19 Morbidity and Mortality Among Patients With Autoimmune Diseases at King Abdulaziz University Hospital. Cureus 2024; 16:e52492. [PMID: 38370992 PMCID: PMC10874129 DOI: 10.7759/cureus.52492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has raised significant concerns about the effects of the virus on patients with autoimmune diseases. Therefore, understanding the COVID-19 outcomes in this population is crucial for effective prevention and management. Objective This study aimed to investigate the association between autoimmune diseases and the severity of COVID-19 in terms of mortality and morbidity. Despite substantial advancements in pandemic-related research concerning COVID-19 and autoimmune diseases, there remain noteworthy gaps in our comprehension of this association, particularly due to limited investigations conducted in Saudi Arabia. Methods This was a retrospective record review of a tertiary center from January 2020 to January 2022. We included 120 patients, among whom 40 were diagnosed with autoimmune diseases, and 80 were age- and sex-matched controls. Afterward, we assessed their demographics, year of admission, intensive care unit (ICU) admission, health status, length of hospitalization, comorbidities, diagnosis of autoimmune diseases, and type of immunosuppressant therapy. Results Most of the included patients (mean age: 45.4 years) were females (65.8%). The ratio of non-autoimmune diseases to autoimmune diseases was 2:1, the mean length of hospitalization was 8.83 ± 8.16 days, and the median was seven days (interquartile range (IQR) = 3 to 11 days). Among them, 17.5% were admitted to the ICU and 10% died. The prevalence of autoimmune diseases was higher in women than in men (77.5%). The most common diseases were systemic lupus erythematosus (40%), rheumatoid arthritis (20%), and ankylosing spondylitis (10%). Regarding COVID-19 outcomes, ICU admissions were higher among patients with autoimmune diseases than those with non-autoimmune diseases (35% vs. 8.8%) (p<0.05). This trend was also observed in mortality, with a higher percentage of deaths among patients with autoimmune diseases (27.5% vs. 1.7%) (p<0.05). In addition, there were no significant differences between genders in terms of ICU admission, health status outcomes, or length of hospitalization among patients with autoimmune diseases (p>0.05). Notably, 25 patients were administered immunosuppressants. Of these, 18 (72%) used steroids only, while seven (28%) used both biological and steroid therapy. However, no significant associations were observed between the type of treatment used and outcomes such as ICU admission, health status at discharge, and length of hospitalization (p>0.05). Conclusion This study suggests that individuals with autoimmune diseases have more severe COVID-19 outcomes, as shown by ICU admission and mortality rates, than patients with non-autoimmune diseases. Furthermore, we observed that the use of immunosuppressant medications among patients with autoimmune diseases showed no noticeable effect on these outcomes.
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Affiliation(s)
| | - Abdulah H Ali
- Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Abdulaziz A Alariefy
- Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Sami Bahlas
- Department of Medicine/Rheumatology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Samer K AlZahrani
- Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Essam W Zarei
- Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Adnan E Alshaikh
- Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ahmed H Khan
- Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Abdullah A Attar
- Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Yadaw AS, Sahner DK, Sidky H, Afzali B, Hotaling N, Pfaff ER, Mathé EA. Preexisting Autoimmunity Is Associated With Increased Severity of Coronavirus Disease 2019: A Retrospective Cohort Study Using Data From the National COVID Cohort Collaborative (N3C). Clin Infect Dis 2023; 77:816-826. [PMID: 37207367 PMCID: PMC10506777 DOI: 10.1093/cid/ciad294] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Identifying individuals with a higher risk of developing severe coronavirus disease 2019 (COVID-19) outcomes will inform targeted and more intensive clinical monitoring and management. To date, there is mixed evidence regarding the impact of preexisting autoimmune disease (AID) diagnosis and/or immunosuppressant (IS) exposure on developing severe COVID-19 outcomes. METHODS A retrospective cohort of adults diagnosed with COVID-19 was created in the National COVID Cohort Collaborative enclave. Two outcomes, life-threatening disease and hospitalization, were evaluated by using logistic regression models with and without adjustment for demographics and comorbidities. RESULTS Of the 2 453 799 adults diagnosed with COVID-19, 191 520 (7.81%) had a preexisting AID diagnosis and 278 095 (11.33%) had a preexisting IS exposure. Logistic regression models adjusted for demographics and comorbidities demonstrated that individuals with a preexisting AID (odds ratio [OR], 1.13; 95% confidence interval [CI]: 1.09-1.17; P < .001), IS exposure (OR, 1.27; 95% CI: 1.24-1.30; P < .001), or both (OR, 1.35; 95% CI: 1.29-1.40; P < .001) were more likely to have a life-threatening disease. These results were consistent when hospitalization was evaluated. A sensitivity analysis evaluating specific IS revealed that tumor necrosis factor inhibitors were protective against life-threatening disease (OR, 0.80; 95% CI: .66-.96; P = .017) and hospitalization (OR, 0.80; 95% CI: .73-.89; P < .001). CONCLUSIONS Patients with preexisting AID, IS exposure, or both are more likely to have a life-threatening disease or hospitalization. These patients may thus require tailored monitoring and preventative measures to minimize negative consequences of COVID-19.
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Affiliation(s)
- Arjun S Yadaw
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - David K Sahner
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - Hythem Sidky
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - Behdad Afzali
- Immunoregulation Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Nathan Hotaling
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - Emily R Pfaff
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ewy A Mathé
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
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Mehrotra‐Varma J, Kumthekar A, Henry S, Fleysher R, Hou W, Duong TQ. Hospitalization, Critical Illness, and Mortality Outcomes of COVID-19 in Patients With Rheumatoid Arthritis. ACR Open Rheumatol 2023; 5:465-473. [PMID: 37530460 PMCID: PMC10502846 DOI: 10.1002/acr2.11580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE To investigate the clinical outcomes of patients with rheumatoid arthritis (RA) with COVID-19. METHODS This retrospective study consisted of 361 patients with RA+ and 45,954 patients with RA- (March 2020 to August 2022) who tested positive for SARS-CoV-2 by polymerase-chain-reaction in the Montefiore Health System, which serves a large low-income, minority-predominant population in the Bronx and was an epicenter of the initial pandemic and subsequent surges. Primary outcomes were hospitalization, critical illness, and all-cause mortality associated with SARS-CoV-2 infection. Comparisons were made with and without adjustment for covariates, as well as with 1083 matched controls of patients with RA- and COVID-19. RESULTS Patients with RA+ and COVID-19 were older (62.2 ± 23.5 vs. 45.5 ± 26.3; P < 0.001), were more likely females (83.1% vs. 55.8%; P < 0.001), were Black (35.5% vs. 30.3%; P < 0.05), and had higher rates of comorbidities (P < 0.05), hospitalization (52.4% vs. 32.5%; P < 0.005), critical illness (10.5% vs. 6.9%; P < 0.05), and mortality (11.1% vs. 6.2%; P < 0.01) compared with patients with RA- and COVID-19. Patients with RA+ with COVID-19 had higher odds of critical illness (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.09-1.93; P = 0.008) but no differences in hospitalization (aOR = 1.18 [95% CI: 0.93-1.49]; P = 0.16) and mortality (aOR = 1.34 [95% CI: 0.92-1.89]; P = 0.10) after adjusting for covariates. Odds ratio analysis identified age, hospitalization status, female sex, chronic kidney disease, chronic obstructive pulmonary disease, and Black race to be significant risk factors for COVID-19-related mortality. Pre-COVID-19 steroid and biologic therapy to treat RA were not significantly associated with worse outcomes (P > 0.05). Outcomes were not different between patients with RA+ and propensity-matched RA- controls (P > 0.05). CONCLUSION Our findings suggest that risk factors for adverse COVID-19 outcomes were not attributed to RA per se but rather age and preexisting medical conditions of patients with RA.
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Affiliation(s)
- Jai Mehrotra‐Varma
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Anand Kumthekar
- Department of Medicine, Division of Rheumatology, Albert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Sonya Henry
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Roman Fleysher
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Wei Hou
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
| | - Tim Q. Duong
- Department of RadiologyAlbert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
- Center for Health Data Innovation, Albert Einstein College of Medicine and Montefiore Medical CenterBronxNew York
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Ughi N, Bernasconi DP, Gagliardi C, Del Gaudio F, Dicuonzo A, Maloberti A, Giannattasio C, Rossetti C, Valsecchi MG, Epis OM. Trends in severe outcomes in SARS-CoV-2-positive hospitalized patients with rheumatic diseases: a monocentric observational and case-control study in northern Italy. Reumatismo 2023; 75. [PMID: 37462130 DOI: 10.4081/reumatismo.2023.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 07/20/2023] Open
Abstract
Rheumatic disease patients are at greater risk of infection due to their disease, comorbidities, and immunosuppressive therapy. COVID-19 outcomes in this patient setting appeared to be similar to those of the general population. However, data on this topic were mainly related to small studies on a limited number of patients. Consequently, to date, this field remains poorly explored, particularly in the pre-vaccine era. This monocentric study aimed to describe the intrahospital mortality in rheumatic patients with SARS-CoV-2 consecutively hospitalized from 21 February to 31 December 2020, before anti-SARS-CoV-2 vaccine administration spread, compared with non-rheumatic patients. Of 2491 included patients, 65 [3%, median (interquartile range) age 75 (64.76-82.239 years, 65% women] were suffering from rheumatic diseases. A total of 20 deaths were reported [case fatality rate 31%, 95% confidence interval (CI): 19-42] compared with 433 deaths (19%, 95% CI: 17-20) in patients without rheumatic diseases (p=0.024). However, the rheumatic disease was not associated with a significant increase in univariate mortality hazards (hazard ratio 1.374, 95% CI: 0.876-2.154), and after adjustment (hazard ratio 1.199, 95% CI: 0.759-1.894) by age, sex and Charlson comorbidity index. The incidence of intensive care unit admission, death, and discharge in the case-control study was comparable between rheumatic and non-rheumatic patients. The presence of rheumatic diseases in SARS-CoV-2-hospitalized patients did not represent an independent risk factor for severe disease or mortality.
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Affiliation(s)
- N Ughi
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
| | - D P Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center-B4, School of Medicine and Surgery, Milano-Bicocca University, Milan.
| | - C Gagliardi
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
| | - F Del Gaudio
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - A Dicuonzo
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - A Maloberti
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan; School of Medicine and Surgery, Milano-Bicocca University, Milan .
| | - C Giannattasio
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan; School of Medicine and Surgery, Milano-Bicocca University, Milan .
| | - C Rossetti
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - M G Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center-B4, School of Medicine and Surgery, Milano-Bicocca University, Milan.
| | - O M Epis
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
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COVID-19 Adverse Outcomes in Immunocompromised Patients. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2023. [DOI: 10.5812/ijcm-131077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a devastating viral pandemic infecting millions of people with a wide range of symptoms from fever to death. It has been suggested that immunocompromised patients are at a higher risk of severe disease, poor clinical outcomes, and mortality. However, these patients’ risk factors and COVID-19-related outcomes are not well characterized. Objectives: We evaluated the COVID-19-related outcomes among immunocompromised patients ranging from solid tumors, hematological malignancies, and HIV to autoimmune disease and transplant recipients who received immunosuppressive agents. We also aimed at finding risk factors related to mortality among immunocompromised patients with COVID-19. Methods: This cross-sectional study was conducted in Khansari Hospital, Iran between March and November 2021. We included immunocompromised patients with nasal swab positive SARS-CoV-2 polymerase chain reaction (PCR) results in the study. Patient outcomes, including hospitalization ward and the mortality rate, were assessed till three months after COVID-19 infection were evaluated in all patients. Moreover, the relation between risk factors and the rate of the mortality rate was analyzed in immunocompromised patients with COVID-19. Results: A total number of 74 immunocompromised patients with solid tumors, hematologic malignancies, autoimmune diseases, acquired immunodeficiencies, and solid-organ transplant recipients were included in the study. Results indicated that the male gender and ICU hospitalization significantly increase the mortality risk. Surprisingly, chemotherapy is associated with a lower risk of mortality. Conclusions: Identifying the risk factors can improve the decision-making on cancer patients’ management during the COVID-19 infection. A further large cohort of patients would be required to identify risk factors relating to poor clinical outcomes and mortality rates in immunocompromised patients with COVID-19.
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Yadaw AS, Afzali B, Hotaling N, Sidky H, Pfaff ER, Sahner DK, Mathé EA. Pre-existing autoimmunity is associated with increased severity of COVID-19: A retrospective cohort study using data from the National COVID Cohort Collaborative (N3C). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.02.23285353. [PMID: 36778264 PMCID: PMC9915827 DOI: 10.1101/2023.02.02.23285353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Importance Identifying individuals with a higher risk of developing severe COVID-19 outcomes will inform targeted or more intensive clinical monitoring and management. Objective To examine, using data from the National COVID Cohort Collaborative (N3C), whether patients with pre-existing autoimmune disease (AID) diagnosis and/or immunosuppressant (IS) exposure are at a higher risk of developing severe COVID-19 outcomes. Design setting and participants A retrospective cohort of 2,453,799 individuals diagnosed with COVID-19 between January 1 st , 2020, and June 30 th , 2022, was created from the N3C data enclave, which comprises data of 15,231,849 patients from 75 USA data partners. Patients were stratified as those with/without a pre-existing diagnosis of AID and/or those with/without exposure to IS prior to COVID-19. Main outcomes and measures Two outcomes of COVID-19 severity, derived from the World Health Organization severity score, were defined, namely life-threatening disease and hospitalization. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression models with and without adjustment for demographics (age, BMI, gender, race, ethnicity, smoking status), and comorbidities (cardiovascular disease, dementia, pulmonary disease, liver disease, type 2 diabetes mellitus, kidney disease, cancer, and HIV infection). Results In total, 2,453,799 (16.11% of the N3C cohort) adults (age> 18 years) were diagnosed with COVID-19, of which 191,520 (7.81%) had a prior AID diagnosis, and 278,095 (11.33%) had a prior IS exposure. Logistic regression models adjusted for demographic factors and comorbidities demonstrated that individuals with a prior AID (OR = 1.13, 95% CI 1.09 - 1.17; p =2.43E-13), prior exposure to IS (OR= 1.27, 95% CI 1.24 - 1.30; p =3.66E-74), or both (OR= 1.35, 95% CI 1.29 - 1.40; p =7.50E-49) were more likely to have a life-threatening COVID-19 disease. These results were confirmed after adjusting for exposure to antivirals and vaccination in a cohort subset with COVID-19 diagnosis dates after December 2021 (AID OR = 1.18, 95% CI 1.02 - 1.36; p =2.46E-02; IS OR= 1.60, 95% CI 1.41 - 1.80; p =5.11E-14; AID+IS OR= 1.93, 95% CI 1.62 - 2.30; p =1.68E-13). These results were consistent when evaluating hospitalization as the outcome and also when stratifying by race and sex. Finally, a sensitivity analysis evaluating specific IS revealed that TNF inhibitors were protective against life-threatening disease (OR = 0.80, 95% CI 0.66-0.96; p =1.66E-2) and hospitalization (OR = 0.80, 95% CI 0.73 - 0.89; p =1.06E-05). Conclusions and Relevance Patients with pre-existing AID, exposure to IS, or both are more likely to have a life-threatening disease or hospitalization. These patients may thus require tailored monitoring and preventative measures to minimize negative consequences of COVID-19.
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Affiliation(s)
- Arjun S. Yadaw
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
| | - Behdad Afzali
- Immunoregulation Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, Bethesda, MD, USA
| | - Nathan Hotaling
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
| | - Hythem Sidky
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
| | - Emily R Pfaff
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David K. Sahner
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
| | - Ewy A. Mathé
- National Center for Advancing Translational Sciences (NCATS), NIH, Rockville, MD, USA
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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Mehta P, Gasparyan AY, Zimba O, Kitas GD, Yessirkepov M. Interplay of diabetes mellitus and rheumatic diseases amidst the COVID-19 pandemic: influence on the risk of infection, outcomes, and immune responses. Clin Rheumatol 2022; 41:3897-3913. [PMID: 36076125 PMCID: PMC9458477 DOI: 10.1007/s10067-022-06365-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022]
Abstract
Outcomes of COrona VIrus Disease-19 (COVID-19) in patients with rheumatic diseases (RDs) reported in various studies are heterogenous owing to the influence of age and comorbidities which have a significant bearing on the infection risk, severity, morbidity, and mortality. Diabetes mellitus (DM) and RDs are closely linked with underlying pathobiology and treatment of RDs affecting the risk for DM as well as the glycemic control. Hence, we undertook this narrative review to study the influence of DM on outcomes of COVID-19 in patients with RDs. Additionally, aspects of patient attitudes and immune response to COVID-19 vaccination were also studied. The databases of MEDLINE/PubMed, Scopus, and Directory of Open Access Journals (DOAJ) were searched for relevant articles. Studies from mixed cohorts revealed insufficient data to comment on the influence of DM on the risk of infection, while most studies showed twice the odds for hospitalization and mortality with DM. Specific cohorts of rheumatoid arthritis and systemic lupus erythematosus revealed a similar association. Poor health was noted in patients with spondyloarthritis and DM during the pandemic. The presence of DM did not affect patient attitudes towards vaccination and did not predispose to additional vaccine-related adverse effects. Immune response to inactivated vaccines was reduced but mRNA vaccines were maintained in patients with DM. Detailed assessment of DM with its duration, end-organ damage, and glycemic control along with a focused association of DM with various aspects of COVID-19 like risk, hospitalization, severity, mortality, post-COVID sequelae, immune response to infection, and vaccination are needed in the future. Key Points • Diabetes mellitus is associated with the severity of infection, COVID-19-related hospitalization, and mortality in rheumatic diseases across most studies but studies analyzing its specific role are lacking. • Poor outcomes of COVID-19 in RA and poor health in spondyloarthritis are strongly associated with diabetes mellitus. • Diabetes mellitus may negatively influence the humoral response to inactivated vaccines but does not seem to affect the immune responses to mRNA vaccines. • Diabetes mellitus does not influence the attitude towards vaccination or deviation from the prescribed medications during the pandemic.
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Affiliation(s)
- Pankti Mehta
- Department of Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, India
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK.
| | - Olena Zimba
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - George D Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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Figueroa-Parra G, Gilbert EL, Valenzuela-Almada MO, Vallejo S, Neville MR, Patel NJ, Cook C, Fu X, Hagi R, McDermott GC, Dilorio MA, Masto L, Vanni KMM, Kowalski E, Qian G, Zhang Y, Wallace ZS, Duarte-García A, Sparks JA. Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: a retrospective, comparative, multicentre cohort study. THE LANCET. RHEUMATOLOGY 2022; 4:e765-e774. [PMID: 36118532 PMCID: PMC9472567 DOI: 10.1016/s2665-9913(22)00227-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Rheumatoid arthritis has been associated with severe COVID-19, but few studies have investigated how phenotypes of rheumatoid arthritis affect these associations. We aimed to investigate the associations between rheumatoid arthritis and phenotypes of interstitial lung disease, serostatus, and bone erosions with COVID-19 severity. Methods We did a retrospective, comparative, multicentre cohort study at two large health-care systems (Mayo Clinic [19 hospitals and affiliated outpatient centres] and Mass General Brigham [14 hospitals and affiliated outpatient centres]) in the USA. Consecutive patients with rheumatoid arthritis meeting the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria and who had COVID-19 between March 1, 2020, and June 6, 2021, were matched 1:5 on age, sex, and calendar date with patients without rheumatoid arthritis (comparators). Data were received from electronic health records from Mayo Clinic and Mass General Brigham. We examined subgroups of patients with rheumatoid arthritis by phenotypic features: rheumatoid arthritis-associated interstitial lung disease, seropositivity (for anti-cyclic citrullinated peptide, rheumatoid factor, or both), and bone erosions. Severe COVID-19 was a composite of hospitalisation or death. We used Cox regression to estimate hazard ratios (HR) for severe COVID-19, comparing rheumatoid arthritis and subgroups to the comparator group. Findings We identified 582 patients with rheumatoid arthritis and 2875 matched comparators, all of whom had COVID-19 within the study dates. The mean age of those with rheumatoid arthritis was 62 [SD 14] years, 421 (72%) of 582 were women and 161 (28%) were men, 457 (79%) were White, 65 (11%) were Hispanic or Latino, and 41 (7%) were Black. Among patients with rheumatoid arthritis, 50 (9%) of 582 had interstitial lung disease, 388 (68%) of 568 were seropositive, and 159 (27%) of 582 had bone erosions. Severe COVID-19 occurred in 126 (22%) of 582 patients with rheumatoid arthritis versus 363 (13%) 2875 in the comparator group. Patients with rheumatoid arthritis had an HR of 1·75 (95% CI 1·45-2·10) for severe COVID-19 versus the comparator group. Patients with rheumatoid arthritis-associated interstitial lung disease had an HR of 2·50 (1·66-3·77) versus the comparator group for severe COVID-19. The risk for severe COVID-19 was also higher in patients with rheumatoid arthritis who were seropositive (HR 1·97 [95% CI 1·58-2·46]) or had erosive disease (1·93 [1·41-2·63]) than for those in the comparator group. Interpretation Patients with rheumatoid arthritis have an increased risk of severe COVID-19 across phenotypic subgroups, especially among patients with interstitial lung disease. These findings suggest that rheumatoid arthritis with interstitial lung disease, or its treatment, might be a substantial contributor to severe COVID-19 outcomes for patients with rheumatoid arthritis. Funding None.
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Affiliation(s)
| | - Emily L Gilbert
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Matthew R Neville
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Phoenix, AZ, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Claire Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Ramla Hagi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory C McDermott
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael A Dilorio
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucy Masto
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
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Shirzad Moghadam F, Kianfar N, Dasdar S, Samii R, Farimani Z, Azar PM, Balighi K, Abedini R, Soori T, Salehi Farid A, Mahmoudi H, Daneshpazhooh M. Adverse outcome and severity of COVID-19 in patients with autoimmune bullous diseases: a historical cohort study. Dermatol Ther 2022; 35:e15672. [PMID: 35768959 PMCID: PMC9349909 DOI: 10.1111/dth.15672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
The ongoing COVID‐19 pandemic has raised concerns regarding the outcome of this infection in patients with autoimmune bullous dermatoses (AIBDs) due to effect of drugs used to treat these disorders. This investigation was performed from the onset of the pandemic to June 1, 2021. Patients with AIBDs who contracted COVID‐19 were evaluated. A generalized linear model was employed to find the predictors of severe COVID‐19 among patients with AIBDs. Ninety‐three patients with AIBDs with a mean age of 50.3 years were evaluated. The most COVID‐19 related symptoms were tiredness (76.3%) myalgia (69%), and cough (63.4%). During follow‐up, the rate of hospitalization and death were 45.2% and 4.3%, respectively. Previous comorbidities (β = 0.61) and mean prednisolone dosage above 10 mg/day in the last 3 months (β = 1.10) significantly increased COVID‐19 severity. Also, vaccination against SARS‐CoV‐2 (β = −1.50) and each passing month from the last rituximab dose decreased severity (β = −0.02). Notably, 19.3% of the patients developed AIBD flare‐ups following COVID‐19 infection. Higher prednisone dose and the shorter interval from the last rituximab infusion were determinants of severe COVID‐19. Physicians should assess the risk versus the benefits when prescribing the medications. Moreover, vaccination could successfully attenuate COVID‐19 severity.
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Affiliation(s)
- Fateme Shirzad Moghadam
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nika Kianfar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Dasdar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rana Samii
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Farimani
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Molhem Azar
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedini
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Soori
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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11
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Eder L, Croxford R, Drucker AM, Mendel A, Kuriya B, Touma Z, Johnson SR, Cook R, Bernatsky S, Haroon N, Widdifield J. COVID-19 hospitalizations, intensive care unit stays, ventilation and death among patients with immune mediated inflammatory diseases compared to controls. J Rheumatol 2022; 49:523-530. [DOI: 10.3899/jrheum.211012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 12/15/2022]
Abstract
Objective To investigate COVID-19 hospitalization risk in patients with immune mediated inflammatory diseases (IMIDs) compared with matched non-IMID comparators from the general population. Methods We conducted a population-based, matched cohort study using health administrative data from January to July 2020 in Ontario, Canada. Cohorts for each of the following IMIDs were assembled: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PsA), ankylosing spondylitis, systemic autoimmune rheumatic diseases (SARDs), multiple sclerosis (MS), iritis, inflammatory bowel disease, polymyalgia rheumatica and vasculitis. Each patient was matched with 5 non-IMID comparators based on socio-demographic factors. We compared the cumulative incidence of hospitalizations for COVID-19 and their outcomes between IMID and non-IMID patients. Results A total of 493,499 IMID patients (417 hospitalizations) and 2,466,946 non-IMID comparators (1,519 hospitalizations) were assessed. The odds of being hospitalized for COVID- 19 was significantly higher in patients with IMIDs compared with their matched non-IMID comparators (matched unadjusted Odds Ratio (OR) 1.37, adjusted OR 1.23). Significantly higher risk of hospitalizations was found in patients with iritis (OR 1.46), MS (OR 1.83), PsA (OR 2.20), RA (OR 1.42), SARDs (OR 1.47) and vasculitis (OR 2.07). COVID-19 hospitalizations were associated with older age, male sex, long-term care residence, multimorbidity, and lower income. The odds of complicated hospitalizations was 21% higher among all IMID versus matched non-IMID patients, but this association was attenuated after adjusting for demographic factors and comorbidities. Conclusion Patients with IMIDs were at higher risk of being hospitalized with COVID-19. This risk was explained in part by their comorbidities.
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12
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Humoral immune response to COVID-19 infection or vaccination among celiac disease patients. Cent Eur J Immunol 2022; 47:267-274. [PMID: 36817269 PMCID: PMC9896984 DOI: 10.5114/ceji.2022.118649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Celiac disease (CD) is the most common autoimmune disease (AD) of the small intestine, affecting 1-2% of the population globally. It is characterized by the serological presence of autoantibodies (Abs), tissue transglutaminase antibody (tTGA), immunoglobulin (Ig) A, and IgG. Production of antibodies against SARS-CoV-2 after infection with the virus or vaccination is not well understood, especially among CD patients. The goal of this study was to measure the IgG antibodies in Jordanian patients infected with or vaccinated against the SARS-CoV-2 virus with different types of vaccines (Pfizer- BioNTech BNT162b2, Sinopharm BBIBP-CorV or Oxford-AstraZeneca ChAdOx1-S) and compare them with the levels in non-celiac controls. IgG levels induced by different vaccines were also compared. Material and methods The data for this cross-sectional study were obtained via a survey, whereby respondents were identified through convenience sampling. The healthy controls were given Questionnaire A while CD patients completed Questionnaire B. The blood samples from all participants were tested for the COVID-19 nucleocapsid protein (NP) IgG serum levels for participants previously infected with SARS-CoV-2, and spike (S) protein (S1/S2) IgG serum levels for vaccine recipients. Results The study involved 116 individuals, 60 (51.7%) of whom were CD patients. The NP IgG serum levels in the infected and S1/S2 IgG levels in the vaccinated CD patients were significantly lower than the levels in controls (48.3 ±44.5 vs. 81.1 ±34.4 and 49 ±45.8 vs. 75.7 ±38.6, p = 0.002). Moreover, only the Pfizer vaccine induced significantly more IgG antibodies in controls compared to CD patients (88.8 ±29.1 vs. 58.3 ±45.4, p = 0.01). On the other hand, the IgG levels were significantly higher in CD patients who received the Pfizer relative to the AstraZeneca vaccine (58.3 ±45.5 vs. 13.0 ±23.6, p = 0.03). After adjusting for presence of CD, age, sex, body mass index (BMI), comorbidities, vaccine type, smoking, gluten adherence, and time since infection or vaccination, SARS-CoV-2 S1/S2 IgG Abs and/or NP IgG Abs positivity was significantly associated with CD absence and negatively with vaccine type (AstraZeneca) with the odds ratios (ORs) of 9.6 (95% CI = 1.5-59.2, p = 0.015) and 0.03 (95% CI = 0.004-0.244. p = 0.001), respectively. Conclusions We concluded that patients with CD had lower SARS-CoV-2 S1/S2 IgG Abs and NP IgG Abs levels than controls, and CD patients who received the Pfizer vaccine had higher IgG levels than patients who received the AstraZeneca vaccine. We recommend that further research be conducted to address the dynamics of the antibody responses in CD patients regarding COVID-19 infection.
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13
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Elli L, Facciotti F, Lombardo V, Scricciolo A, Sanders DS, Vaira V, Barisani D, Vecchi M, Costantino A, Scaramella L, dell'Osso B, Doneda L, Roncoroni L. Anti-SARS-CoV-2 immunoglobulin profile in patients with celiac disease living in a high incidence area. Dig Liver Dis 2022; 54:3-9. [PMID: 34561158 PMCID: PMC8429410 DOI: 10.1016/j.dld.2021.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM How symptoms and antibodies related to SARS-CoV-2 infection develop in patients with celiac disease (CD) is unclear. We aimed to investigate the impact of SARS-CoV-2 infection in CD patients. METHODS CD patients were interviewed about the development of COVID-19 symptoms, compliance with anti-virus measures and adherence to a gluten-free diet (GFD). The presence of anti-SARS-CoV-2 IgG and IgA (anti-RBD and N proteins) was compared to that in non-CD subjects. Expression of the duodenal ACE2 receptor was investigated. When available, data on duodenal histology, anti-tissue transglutaminase IgA (tTGA), comorbidities and GFD adherence were analyzed. RESULTS Of 362 CD patients, 42 (12%) reported COVID-19 symptoms and 21% of these symptomatic patients presented anti-SARS-CoV-2 Ig. Overall, 18% of CD patients showed anti-SARS-CoV-2 Ig versus 25% of controls (p = 0.18). CD patients had significantly lower levels of anti-N IgA. tTGA, duodenal atrophy, GFD adherence or other comorbidities did not influence symptoms and/or antibodies. The ACE2 receptor was detected in the non-atrophic duodenal mucosa of patients; atrophy was associated with lower expression of the ACE2 receptor. CONCLUSION CD patients have an anti-SARS-CoV-2 Ig profile similar to non-celiac controls, except for anti-N IgA. No risk factors were identified among CD parameters and GFD adherence.
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Affiliation(s)
- Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Federica Facciotti
- European Institute of Oncology IRCCS, Department of Experimental Oncology, Milan, Italy
| | - Vincenza Lombardo
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alice Scricciolo
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Valentina Vaira
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Donatella Barisani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Costantino
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bernardo dell'Osso
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milan, Milan, Italy; ″Aldo Ravelli" Center for Neurotechnology and Brain Therapeutics, University of Milan, Milan, Italy; CRC Molecular Basis of Neuro-Psycho-Geriatrics Diseases, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Luisa Doneda
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Leda Roncoroni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Centre for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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14
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Risk of Severe COVID-19 Outcomes Among Patients with Immune-Mediated Inflammatory Diseases or Malignancies: A Retrospective Analysis of Real-World Data in the United States. Adv Ther 2022; 39:5413-5432. [PMID: 36153800 PMCID: PMC9510569 DOI: 10.1007/s12325-022-02293-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/03/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION There are concerns that patients in an immunocompromised state may be at risk for increased coronavirus disease 2019 (COVID-19) severity. The aim of this study was to describe the characteristics of patients with COVID-19 and immune-mediated inflammatory diseases (IMIDs) or malignancies and evaluate their risk of developing severe COVID-19. METHODS Cases of COVID-19 (ICD-10 code U07.1 or U07.2, or positive polymerase chain reaction or antigen test) among patients with IMIDs or malignancies were identified in the US-based Optum® Electronic Health Records database between 1 February 2020 and 3 March 2021. Age- and sex-standardized risks of severe COVID-19 were calculated by condition of interest. The risks were further adjusted by multiple covariates, and 95% confidence intervals were estimated. RESULTS A total of 499,772 patients with COVID-19 were identified (mean [SD] age, 46.9 [20.7] years; 57.0% female). Patients with hematologic cancers (adjusted risk ratio [aRR] 2.0, 1.8-2.1), solid tumors (aRR 1.1, 1.1-1.1), or rheumatoid arthritis (aRR 1.2, 1.1-1.3) had a significantly higher risk of severe COVID-19 compared to the general population of patients with COVID-19. Patients with systemic lupus erythematosus (aRR 1.1, 0.9-1.2), psoriasis (aRR 1.0, 0.7-1.2), ulcerative colitis (aRR 0.9, 0.8-1.1), Crohn's disease (aRR 0.9, 0.7-1.0), or ankylosing spondylitis (aRR 0.8, 0.5-1.0) showed a comparable risk of severe COVID-19. Patients with atopic dermatitis (aRR 0.8, 0.7-0.9) or psoriatic arthritis (aRR 0.8, 0.6-1.0) showed a lower risk of severe COVID-19. CONCLUSIONS The risk of developing severe COVID-19 varied between the studied IMIDs and malignancies. Patients with hematologic cancers, solid tumors, or rheumatoid arthritis had significantly increased risk for severe COVID-19 compared to the general population. These findings highlight the need to protect and monitor immunocompromised patients such as those with IMIDs or malignancies as part of the strategy to control the pandemic worldwide.
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15
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Doskaliuk B, Yatsyshyn R, Klishch I, Zimba O. COVID-19 from a rheumatology perspective: bibliometric and altmetric analysis. Rheumatol Int 2021; 41:2091-2103. [PMID: 34596719 PMCID: PMC8484846 DOI: 10.1007/s00296-021-04987-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/31/2021] [Indexed: 12/22/2022]
Abstract
The Coronavirus disease 2019 (COVID-19) outbreak turned out the greatest pandemic for decades. It challenged enormously the global health system, forcing it to adjust to the new realities. We aimed to analyze articles covering COVID-19 papers in the rheumatological field and outline emerging topics raising within this frame. We applied the bibliometric database Scopus for our literature search and conducted it on the 5th of June using the following keywords: "rheumatic" OR "rheumatology" OR "rheumatoid arthritis" OR "systemic lupus erythematosus" OR "myositis" OR "systemic sclerosis" OR "vasculitis" OR "arthritis" OR "ankylosing spondylitis" AND "COVID-19". We analyzed all selected articles according to various aspects: type of document, authorship, journal, citations score, rheumatology field, country of origin, language, and keywords. With the help of the software tool VOSviewer version 1.6.15, we have built the visualizing network of authors and keywords co-occurrence. The measurement of the social impact of articles was made using Altmetric data. This study included 1430 retrieved articles with open access mostly. The top five journals in this field were Annals of the Rheumatic Diseases (n = 65), Rheumatology International (n = 51), Clinical Rheumatology (n = 50), Lancet Rheumatology (n = 50), and Frontiers In Immunology (n = 33). Most studies originate from countries with a high incidence of COVID-19 among the general population (the USA-387; Italy-268; UK-184; France-114; Germany-110; India-98 and Spain-96, China-94, Canada-73 Turkey-66). Original Articles (42.1%) were the most common articles' type, following by Letters (24.4%), Reviews (21.7%), Notes (6%), Editorials (4.8%), Erratum (1%). According to the citations scores, articles dedicated to the clinical course of COVID-19 in patients with rheumatic diseases were of the highest importance for the scientific rheumatologic community. Rheumatoid arthritis (n = 527), systemic lupus erythematosus (n = 393), vasculitis (n = 267), myositis (n = 71), systemic sclerosis (n = 68), and psoriatic arthritis (n = 68) were the most widely discussed rheumatic diseases in the view of COVID-19. The analysis of Altmetric and citations scores revealed a moderate correlation between them. This article provides a comprehensive bibliometric and altmetric analysis of COVID-19 related articles in the rheumatology field and summarizes data about features of rheumatology service in the time of the pandemic.
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Affiliation(s)
- Bohdana Doskaliuk
- Academician Ye. M. Neiko Department of Internal Medicine #1, Clinical Immunology and Allergology, Ivano-Frankivsk National Medical University, Halytska str. 2, Ivano-Frankivsk, 76000 Ukraine
| | - Roman Yatsyshyn
- Academician Ye. M. Neiko Department of Internal Medicine #1, Clinical Immunology and Allergology, Ivano-Frankivsk National Medical University, Halytska str. 2, Ivano-Frankivsk, 76000 Ukraine
| | - Iryna Klishch
- Department of Pathophysiology, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Olena Zimba
- Department of Internal Medicine #2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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16
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Yuki EFN, Borba EF, Pasoto SG, Seguro LP, Lopes M, Saad CGS, Medeiros‐Ribeiro AC, Silva CA, de Andrade DCO, Kupa LDVK, Betancourt L, Bertoglio I, Valim J, Hoff C, Formiga FC, Pedrosa T, Kallas EG, Aikawa NE, Bonfa E. Impact of distinct therapies on antibody response to SARS-CoV-2 vaccine in systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2021; 74:562-571. [PMID: 34806342 PMCID: PMC9011410 DOI: 10.1002/acr.24824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 11/07/2022]
Abstract
Objective To date, the only study that has assessed the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2 mRNA) vaccine in systemic lupus erythematosus (SLE) observed a moderate response, but the sample size precluded an accurate analysis of the effect of individual drugs. Therefore, we evaluated the immunogenicity of an inactivated SARS‐CoV‐2 vaccine (Sinovac‐CoronaVac) and the influence of different medications in SLE. Safety was also assessed. Methods We conducted a prospective controlled study of 232 SARS‐CoV‐2–naive SLE patients and 58 SARS‐CoV‐2–naive controls who were vaccinated with 2 doses of Sinovac‐CoronaVac with a 28‐day interval (day 0/day 28 [D0/D28]). Immunogenicity analysis at D0/D28 and D69 included anti‐SARS‐CoV‐2 S1/S2 IgG seroconversion (SC) and neutralizing antibodies (NAb) positivity. The influence of individual drugs on immune response and safety was assessed. Results Patients and controls were well balanced for age (P = 0.771). At D69, SLE patients showed a moderate SC (70.2% versus 98.1%; P < 0.001) and moderate frequency of NAb positivity (61.5% versus 84.6%; P = 0.002), although both frequencies were lower than in controls. Factors associated with lower SC in univariate analysis at D69 were prednisone use (odds ratio [OR] 0.215 [95% confidence interval (95% CI) 0.108–0.427], P < 0.001) and mycophenolate mofetil (MMF) use (OR 0.201 [95% CI 0.107–0.378], P < 0.001), whereas hydroxychloroquine (HCQ) use led to a 2.5 increase in SC (P = 0.011). SLE patients who were receiving HCQ monotherapy had similar SC to controls at D69 (100% versus 98.1%; P = 1.000). In multivariate analysis, prednisone and MMF use were independently associated with lower SC (P < 0.001) and NAb positivity (P < 0.001). Safety analysis revealed no moderate/severe adverse events. Conclusion Sinovac‐CoronaVac has a moderate immunogenicity in SARS‐CoV‐2–naive SLE patients with an excellent safety profile. We further demonstrate that HCQ may improve SC, whereas prednisone and MMF had a major deleterious effect in vaccine response, reinforcing the need to investigate the role of temporary MMF withdrawal or a vaccine‐booster dose (ClinicalTrials.gov identifier: NCT04754698).
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Affiliation(s)
- Emily F. N. Yuki
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Eduardo F. Borba
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Sandra G. Pasoto
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Luciana P. Seguro
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Michelle Lopes
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Carla G. S. Saad
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | | | - Clovis A. Silva
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | | | | | - Lorena Betancourt
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Isabela Bertoglio
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Juliana Valim
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Camilla Hoff
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Francisco F. C. Formiga
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Tatiana Pedrosa
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Esper G. Kallas
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Nadia E. Aikawa
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Eloisa Bonfa
- Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
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17
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Felten R, Scherlinger M, Guffroy A, Poindron V, Meyer A, Giannini M, Korganow AS, Sordet C, Chatelus E, Javier RM, Meyer A, Pijnenburg L, Kleinmann JF, Gottenberg JE, Sibilia J, Martin T, Arnaud L. Incidence and predictors of COVID-19 and flares in patients with rare autoimmune diseases: a systematic survey and serological study at a national reference center in France. Arthritis Res Ther 2021; 23:188. [PMID: 34256812 PMCID: PMC8276223 DOI: 10.1186/s13075-021-02565-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/24/2021] [Indexed: 01/12/2023] Open
Abstract
Background The risk of severe COVID-19 and its determinants remain largely unknown in patients with autoimmune and inflammatory rheumatic diseases. The objective of this study was to assess the prevalence of COVID-19 infection in patients followed for rare autoimmune diseases as well as the predictors of COVID-19 and disease flare-ups. Methods Cross-sectional phone survey from April 9, 2020, to July 2, 2020, during which patients with autoimmune diseases followed at the National Reference Center for Rare Autoimmune diseases of Strasbourg were systematically contacted by phone and sent a prescription for a SARS-CoV-2 serology. Results One thousand two hundred thirty-two patients were contacted. One thousand fifty-five patients with a confirmed diagnosis of systemic autoimmune disease were included (4 unreachable, 4 moves abroad, 5 deaths before pandemic, 50 without consent, and 114 without autoimmune disease). Among them, 469 (44.5%) patients were tested for SARS-CoV-2 serology. Thirty-nine patients (7.9%) had SARS-CoV-2 infection (either through chest CT-scan [n = 5], RT-PCR on nasopharyngeal swab [n = 14], or serology [n = 31]) among the 496 who underwent at least one of those 3 diagnosis modalities. Of the 39 proven cases, 33 had clinical manifestations (6 asymptomatic patients were diagnosed through systematic serology testing), 31 were managed by home care, 3 were hospitalized due to a need for oxygenation, two required admission to an intensive care unit, and one died. Among patients with confirmed SARS-CoV-2 infection, reported flares were more frequent than in uninfected patients (26.3% [10/38] vs. 7.0% [32/457], p < 0.0001). Preventive sick leave had no significant impact on the prevalence of SARS-CoV-2 infection (5.8% [3/53]) compared to work continuation (7.6% [30/397], p = 0.64). Overall, the seroprevalence of SARS-CoV-2 was 6.6% (31/469) which was numerically lower to the Grand-Est general population estimated to be 9.0%. Conclusions This systematic survey of more than 1000 patients with rare systemic autoimmune diseases reports a low prevalence of proven SARS-CoV-2 infection and very rare severe infections, probably related to good compliance with prophylactic measures in these patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02565-0.
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Affiliation(s)
- Renaud Felten
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Marc Scherlinger
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Aurélien Guffroy
- Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France.,Service d'immunologie clinique et médecine interne, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France
| | - Vincent Poindron
- Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France.,Service d'immunologie clinique et médecine interne, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France
| | - Alain Meyer
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France.,Service de physiologie et explorations fonctionnelles, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France
| | - Margherita Giannini
- Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France.,Service de physiologie et explorations fonctionnelles, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France
| | - Anne-Sophie Korganow
- Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France.,Service d'immunologie clinique et médecine interne, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France
| | - Christelle Sordet
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Emmanuel Chatelus
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Rose-Marie Javier
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Aurore Meyer
- Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France.,Service d'immunologie clinique et médecine interne, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France
| | - Luc Pijnenburg
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Jean-François Kleinmann
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Jean Sibilia
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France
| | - Thierry Martin
- Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France.,Service d'immunologie clinique et médecine interne, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Service de rhumatologie, Service de rhumatologie, Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, 1 avenue Molière BP 83049, 67098, Strasbourg cedex, France. .,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares Est Sud-Ouest (RESO), Strasbourg, France.
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18
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Marques CDL. COVID-19 and Rheumatic Diseases: It Is Time to Better Understand This Association. J Rheumatol 2021; 48:318-320. [PMID: 34237001 DOI: 10.3899/jrheum.201541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Claudia D L Marques
- C.D. Marques, MD, PhD, Adjunct Professor of Rheumatology, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil.Address correspondence to Dr. C.D. Marques, Hospital das Clínicas, Universidade Federal de Pernambuco. Avenida Professor Moraes Rego, s/n - Recife - PE - CEP 50670-901 - Brazil.
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19
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Lebwohl B, Larsson E, Söderling J, Roelstraete B, Murray JA, Green PHR, Ludvigsson JF. Risk of Severe Covid-19 in Patients with Celiac Disease: A Population-Based Cohort Study. Clin Epidemiol 2021; 13:121-130. [PMID: 33628059 PMCID: PMC7899312 DOI: 10.2147/clep.s294391] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Patients with celiac disease (CeD) are at increased risk of certain viral infections and of pneumococcal pneumonia, raising concerns that they may be susceptible to severe coronavirus disease 2019 (Covid-19). We aimed to quantify the association between CeD and severe outcomes related to Covid-19. Methods We performed a population-based cohort study, identifying individuals with CeD in Sweden, as defined by small intestinal villus atrophy diagnosed at all (n=28) Swedish pathology departments during the years spanning 1969–2017, and alive on February 1, 2020. We compared these patients to controls matched by sex, age, county, and calendar period. We performed Cox proportional hazards with follow-up through July 31, 2020, assessing risk of 1) hospital admission with a primary diagnosis of laboratory-confirmed Covid-19 (co-primary outcome); and 2) severe disease as defined by admission to intensive care unit and/or death attributed to Covid-19 (co-primary outcome). Results Among patients with CeD (n=40,963) and controls (n=183,892), the risk of hospital admission for Covid-19 was 2.9 and 2.2 per 1000 person-years respectively. After adjusting for comorbidities, the risk of hospitalization for Covid-19 was not significantly increased in patients with CeD (HR 1.10; 95% CI 0.80–1.50), nor was the risk of severe Covid-19 increased (HR 0.97; 95% CI 0.59–1.59). Results were similarly null when we compared CeD patients to their non-CeD siblings with regard to these outcomes. Among all patients with CeD and controls hospitalized with a diagnosis of Covid-19 (n=58 and n=202, respectively), there was no significant difference in mortality (HR for CeD compared to controls 0.96; 95% CI 0.46–2.02). Conclusion In this population-based study, CeD was not associated with an increased risk of hospitalization for Covid-19 or intensive care unit and/or death attributed to Covid-19.
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Affiliation(s)
- Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emma Larsson
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Jonas Söderling
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Joseph A Murray
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Peter H R Green
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Jonas F Ludvigsson
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
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20
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Chaudhry F, Jageka C, Levy PD, Cerghet M, Lisak RP. Review of the COVID-19 Risk in Multiple Sclerosis. JOURNAL OF CELLULAR IMMUNOLOGY 2021; 3:68-77. [PMID: 33959727 PMCID: PMC8098748 DOI: 10.33696/immunology.3.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The ongoing pandemic of the novel coronavirus of 2019 (COVID-19) has resulted in over 1 million deaths, primarily affecting older patients with chronic ailments. Multiple sclerosis (MS) patients have been deemed particularly vulnerable given their high rates of disability and increased susceptibility to infections. There have also been concerns regarding disease-modifying therapy (DMT) during the pandemic as many DMTs may increase the risk of infection due to some of their immunosuppressive properties. Furthermore, due to MS-related chronic inflammatory damage within the central nervous system, there have been concerns for worsening neurological injury by COVID-19. This has resulted in an alarmingly high level of anxiety and stress among the MS community leading to a lack of compliance with medications and routine check-ups, and even failure to obtain treatment for relapse. However, there is currently substantial evidence that MS and most DMT usage is not associated with increased COVID-19 severity. MS patients who suffer worse outcomes were more likely to be older and suffer from significant disabilities and comorbid conditions, which would also be expected from those in the general population. Likewise, there is little if any evidence demonstrating an increased susceptibility of MS patients to COVID-19-related neurological complications. Therefore, we aim to summarize the most recent findings related to COVID-19 and MS demonstrating that MS and most DMTs do not appear as risk factors for severe COVID-19.
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Affiliation(s)
- Farhan Chaudhry
- Department of Emergency Medicine and Integrative Biosciences, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
| | - Cristina Jageka
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
| | - Phillip D. Levy
- Department of Emergency Medicine and Integrative Biosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mirela Cerghet
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Robert P Lisak
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine and the Detroit Medical Center, Detroit, MI, USA
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21
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Yang H, Xu J, Liang X, Shi L, Wang Y. Autoimmune diseases are independently associated with COVID-19 severity: Evidence based on adjusted effect estimates. J Infect 2020; 82:e23-e26. [PMID: 33383087 PMCID: PMC7833739 DOI: 10.1016/j.jinf.2020.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Haiyan Yang
- Department of Epidemiology, School of Public Heath, Zhengzhou University, No. 100 of Science avenue, Zhengzhou 450001, China.
| | - Jie Xu
- Department of Epidemiology, School of Public Heath, Zhengzhou University, No. 100 of Science avenue, Zhengzhou 450001, China
| | - Xuan Liang
- Department of Epidemiology, School of Public Heath, Zhengzhou University, No. 100 of Science avenue, Zhengzhou 450001, China
| | - Li Shi
- Department of Epidemiology, School of Public Heath, Zhengzhou University, No. 100 of Science avenue, Zhengzhou 450001, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou 450016, China
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22
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Chaudhry F, Lavandero S, Xie X, Sabharwal B, Zheng YY, Correa A, Narula J, Levy P. Manipulation of ACE2 expression in COVID-19. Open Heart 2020; 7:e001424. [PMID: 33443121 PMCID: PMC7757413 DOI: 10.1136/openhrt-2020-001424] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 is the virus responsible for the ongoing COVID-19 outbreak. The virus uses ACE2 receptor for viral entry. ACE2 is part of the counter-regulatory renin-angiotensin-aldosterone system and is also expressed in the lower respiratory tract along the alveolar epithelium. There is, however, significant controversy regarding the role of ACE2 expression in COVID-19 pathogenesis. Some have argued that decreasing ACE2 expression would result in decreased susceptibility to the virus by decreasing available binding sites for SARS-CoV-2 and restricting viral entry into the cells. Others have argued that, like the pathogenesis of other viral pneumonias, including those stemming from previous severe acute respiratory syndrome (SARS) viruses, once SARS-CoV-2 binds to ACE2, it downregulates ACE2 expression. Lack of the favourable effects of ACE2 might exaggerate lung injury by a variety of mechanisms. In order to help address this controversy, we conducted a literature search and review of relevant preclinical and clinical publications pertaining to SARS-CoV-2, COVID-19, ACE2, viral pneumonia, SARS, acute respiratory distress syndrome and lung injury. Our review suggests, although controversial, that patients at increased susceptibility to COVID-19 complications may have reduced baseline ACE2, and by modulating ACE2 expression one can possibly improve COVID-19 outcomes. Herein, we elucidate why and how this potential mechanism might work.
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Affiliation(s)
- Farhan Chaudhry
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sergio Lavandero
- Advanced Center for Chronic Diseases (ACCDiS), Facultad de Ciencias Quimicas y Farmaceuticas and Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Internal Medicine (Cardiology Division), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Basera Sabharwal
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Ashish Correa
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Phillip Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University School of Medicine, Detroit, Michigan, USA
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23
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Sarmiento-Monroy JC, Espinosa G, Londoño MC, Meira F, Caballol B, Llufriu S, Carrasco JL, Moll-Udina A, Quintana LF, Giavedoni P, Ramírez J, Inciarte-Mundo J, Solana E, Blanco Y, Martinez-Hernandez E, Sepúlveda M, Llorenç V, Prieto-González S, Espígol-Frigolé G, Milisenda JC, Cid MC, Mascaró JM, Blanco I, Barberá JA, Sibila O, Gratacos-Ginès J, Adán A, Agustí A, Sanmartí R, Panés J, Cervera R, Vila J, Soriano A, Gómez-Puerta JA. A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center. J Autoimmun 2020; 117:102580. [PMID: 33338707 PMCID: PMC7836738 DOI: 10.1016/j.jaut.2020.102580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
Background and aim There is increasing interest regarding SARS-CoV-2 infection in patients with autoimmune and immune-mediated inflammatory diseases (AI/IMID) with some discrepancies in different cohorts about their risk and outcomes. The aim was to describe a multidisciplinary cohort of patients with AI/IMID and symptomatic SARS-CoV-2 infection in a single tertiary center and analyze sociodemographic, clinical, and therapeutic factors associated with poor outcomes. Methods A retrospective observational study was conducted from the 1st of March until May 29th, 2020 in a University tertiary hospital in Barcelona, Spain. Patients with an underlying AI/IMID and symptomatic SARS-CoV-2 infection were identified in our local SARS-CoV-2 infection database. Controls (2:1) were selected from the same database and matched by age and gender. The primary outcome was severe SARS-CoV-2 infection, which was a composite endpoint including admission to the intensive care unit (ICU), need for mechanical ventilation (MV), and/or death. Several covariates including age, sex, and comorbidities among others were combined into a multivariate model having severe SARS-CoV-2 as the dependent variable. Also, a sensitivity analysis was performed evaluating AID and IMID separately. Results The prevalence of symptomatic SARS-CoV-2 infection in a cohort of AI/IMID patients was 1.3%. Eighty-five patients with AI/IMID and symptomatic SARS-CoV-2 were identified, requiring hospitalization in 58 (68%) cases. A total of 175 patients admitted for SARS-CoV-2 (58 with AI/IMID and 117 matched-controls) were analyzed. In logistic regression analysis, a significant inverse association between AI/IMID group and severe SARS-CoV-2 (OR 0.28; 95% CI 0.12–0.61; p = 0.001), need of MV (OR 0.20; IC 95% 0.05–0.71; p = 0.014), and ICU admission (OR 0.25; IC 95% 0.10–0.62; p = 0.003) was found. Conclusions Patients with AI/IMID who require admission for SARS-CoV-2 infection have a lower risk of developing severe disease, including the need to stay in the ICU and MV. Patients with AI/IMID fwho required admission for SARS CoV2 infection have a lower risk of developing severe disease. Among patients with AID and IMID, there were no differences in terms of severity. According to the 7-category ordinal scale, maximum oxygen requirement was lower among AI/IMID group.
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Affiliation(s)
| | - Gerard Espinosa
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Maria-Carlota Londoño
- Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain
| | - Fernanda Meira
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Berta Caballol
- Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Sara Llufriu
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Josep Lluis Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Barcelona, Catalonia, Spain
| | - Aina Moll-Udina
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Luis F Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Priscila Giavedoni
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Julio Ramírez
- Muscle Research Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | | | - Elisabeth Solana
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Yolanda Blanco
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | - Maria Sepúlveda
- Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Victor Llorenç
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Sergio Prieto-González
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jose C Milisenda
- Muscle Research Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | - Maria C Cid
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jose M Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Joan Albert Barberá
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Oriol Sibila
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | | | - Alfredo Adán
- Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Alvaro Agustí
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Raimon Sanmartí
- Rheumatology Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Julian Panés
- Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, Biomedical Diagnostic Center, Hospital Clinic, Barcelona Institute for Global Health, University of Barcelona, Barcelona, Catalonia, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain
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