A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases
Abstract Background We conducted this study to identify the influence of prolonged use of hydroxychloroquine (HCQ), glucocorticoids and other immunosuppressants (IS) on occurrence and outcome of COVID-19 in patients with autoimmune rheumatic diseases (AIRDs). Methods This was a prospective, multicen...
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | BMC Rheumatology |
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| Online Access: | https://doi.org/10.1186/s41927-022-00264-0 |
| _version_ | 1818236861685956608 |
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| author | Abhishek Patil K. Chanakya Padmanabha Shenoy S. Chandrashekara Vikram Haridas Sharath Kumar Manisha Daware Ramya Janardana Benzeeta Pinto Ramaswamy Subramanian S. Nagaraj Yogesh Preet Singh Shweta Singhai Ramesh Jois Vikramraj Jain C. Srinivasa B. G. Dharmanand Chethana Dharmapalaiah K. N. Sangeetha Vijay K. Rao Vineeta Shobha |
| author_facet | Abhishek Patil K. Chanakya Padmanabha Shenoy S. Chandrashekara Vikram Haridas Sharath Kumar Manisha Daware Ramya Janardana Benzeeta Pinto Ramaswamy Subramanian S. Nagaraj Yogesh Preet Singh Shweta Singhai Ramesh Jois Vikramraj Jain C. Srinivasa B. G. Dharmanand Chethana Dharmapalaiah K. N. Sangeetha Vijay K. Rao Vineeta Shobha |
| author_sort | Abhishek Patil |
| collection | DOAJ |
| description | Abstract Background We conducted this study to identify the influence of prolonged use of hydroxychloroquine (HCQ), glucocorticoids and other immunosuppressants (IS) on occurrence and outcome of COVID-19 in patients with autoimmune rheumatic diseases (AIRDs). Methods This was a prospective, multicenter, non-interventional longitudinal study across 15 specialist rheumatology centers. Consecutive AIRD patients on treatment with immunosuppressants were recruited and followed up longitudinally to assess parameters contributing to development of COVID-19 and its outcome. Results COVID-19 occurred in 314 (3.45%) of 9212 AIRD patients during a median follow up of 177 (IQR 129, 219) days. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19. Glucocorticoids in moderate dose (7.5–20 mg/day) conferred higher risk (RR = 1.72) of infection. Among the IS, Mycophenolate mofetil (MMF), Cyclophosphamide (CYC) and Rituximab (RTX) use was higher in patients with COVID 19. However, the conventional risk factors such as male sex (RR = 1.51), coexistent diabetes mellitus (RR = 1.64), pre-existing lung disease (RR = 2.01) and smoking (RR = 3.32) were the major contributing risk factors for COVID-19. Thirteen patients (4.14%) died, the strongest risk factor being pre-existing lung disease (RR = 6.36, p = 0.01). Incidence (17.5 vs 5.3 per 1 lakh (Karnataka) and 25.3 vs 7.9 per 1 lakh (Kerala)) and case fatality (4.1% vs 1.3% (Karnataka) and 4.3% vs 0.4% (Kerala)) rate of COVID-19 was significantly higher (p < 0.001) compared to the general population of the corresponding geographic region. Conclusions Immunosuppressants have a differential impact on the risk of COVID-19 occurrence in AIRD patients. Older age, males, smokers, hypertensive, diabetic and underlying lung disease contributed to higher risk. The incidence rate and the case fatality rate in AIRD patients is much higher than that in the general population. |
| first_indexed | 2024-12-12T12:16:36Z |
| format | Article |
| id | doaj.art-b17e9c77df274d7da3b6a55e132e64f2 |
| institution | Directory Open Access Journal |
| issn | 2520-1026 |
| language | English |
| last_indexed | 2024-12-12T12:16:36Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Rheumatology |
| spelling | doaj.art-b17e9c77df274d7da3b6a55e132e64f22022-12-22T00:24:46ZengBMCBMC Rheumatology2520-10262022-06-016111010.1186/s41927-022-00264-0A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseasesAbhishek Patil0K. Chanakya1Padmanabha Shenoy2S. Chandrashekara3Vikram Haridas4Sharath Kumar5Manisha Daware6Ramya Janardana7Benzeeta Pinto8Ramaswamy Subramanian9S. Nagaraj10Yogesh Preet Singh11Shweta Singhai12Ramesh Jois13Vikramraj Jain14C. Srinivasa15B. G. Dharmanand16Chethana Dharmapalaiah17K. N. Sangeetha18Vijay K. Rao19Vineeta Shobha20Manipal HospitalDepartment of Clinical Immunology and Rheumatology, St. John’s Medical College HospitalCARE HospitalChanRe Rheumatology and Immunology CentreArthritis Superspeciality CentreOARCNarayana Health CityDepartment of Clinical Immunology and Rheumatology, St. John’s Medical College HospitalDepartment of Clinical Immunology and Rheumatology, St. John’s Medical College HospitalJSS Medical CollegeColumbia AsiaManipal HospitalSakra HospitalVikram HospitalBhagwan Mahaveer Jain HospitalFortis HospitalVikram HospitalAster CMIAnagha HospitalManipal HospitalDepartment of Clinical Immunology and Rheumatology, St. John’s Medical College HospitalAbstract Background We conducted this study to identify the influence of prolonged use of hydroxychloroquine (HCQ), glucocorticoids and other immunosuppressants (IS) on occurrence and outcome of COVID-19 in patients with autoimmune rheumatic diseases (AIRDs). Methods This was a prospective, multicenter, non-interventional longitudinal study across 15 specialist rheumatology centers. Consecutive AIRD patients on treatment with immunosuppressants were recruited and followed up longitudinally to assess parameters contributing to development of COVID-19 and its outcome. Results COVID-19 occurred in 314 (3.45%) of 9212 AIRD patients during a median follow up of 177 (IQR 129, 219) days. Long term HCQ use had no major impact on the occurrence or the outcome of COVID-19. Glucocorticoids in moderate dose (7.5–20 mg/day) conferred higher risk (RR = 1.72) of infection. Among the IS, Mycophenolate mofetil (MMF), Cyclophosphamide (CYC) and Rituximab (RTX) use was higher in patients with COVID 19. However, the conventional risk factors such as male sex (RR = 1.51), coexistent diabetes mellitus (RR = 1.64), pre-existing lung disease (RR = 2.01) and smoking (RR = 3.32) were the major contributing risk factors for COVID-19. Thirteen patients (4.14%) died, the strongest risk factor being pre-existing lung disease (RR = 6.36, p = 0.01). Incidence (17.5 vs 5.3 per 1 lakh (Karnataka) and 25.3 vs 7.9 per 1 lakh (Kerala)) and case fatality (4.1% vs 1.3% (Karnataka) and 4.3% vs 0.4% (Kerala)) rate of COVID-19 was significantly higher (p < 0.001) compared to the general population of the corresponding geographic region. Conclusions Immunosuppressants have a differential impact on the risk of COVID-19 occurrence in AIRD patients. Older age, males, smokers, hypertensive, diabetic and underlying lung disease contributed to higher risk. The incidence rate and the case fatality rate in AIRD patients is much higher than that in the general population.https://doi.org/10.1186/s41927-022-00264-0Autoimmune rheumatic diseasesSARS-CoV-2 infectionRisk factorsOutcomeHydroxychloroquineGlucocorticoid |
| spellingShingle | Abhishek Patil K. Chanakya Padmanabha Shenoy S. Chandrashekara Vikram Haridas Sharath Kumar Manisha Daware Ramya Janardana Benzeeta Pinto Ramaswamy Subramanian S. Nagaraj Yogesh Preet Singh Shweta Singhai Ramesh Jois Vikramraj Jain C. Srinivasa B. G. Dharmanand Chethana Dharmapalaiah K. N. Sangeetha Vijay K. Rao Vineeta Shobha A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases BMC Rheumatology Autoimmune rheumatic diseases SARS-CoV-2 infection Risk factors Outcome Hydroxychloroquine Glucocorticoid |
| title | A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases |
| title_full | A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases |
| title_fullStr | A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases |
| title_full_unstemmed | A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases |
| title_short | A prospective longitudinal study evaluating the influence of immunosuppressives and other factors on COVID-19 in autoimmune rheumatic diseases |
| title_sort | prospective longitudinal study evaluating the influence of immunosuppressives and other factors on covid 19 in autoimmune rheumatic diseases |
| topic | Autoimmune rheumatic diseases SARS-CoV-2 infection Risk factors Outcome Hydroxychloroquine Glucocorticoid |
| url | https://doi.org/10.1186/s41927-022-00264-0 |
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