ABSTRACT
Background: We assessed the risk factors and outcome of COVID-19 in patients with autoimmune rheumatic diseases (AIRD) who contracted infection while on background treatment with tofacitinib. Method(s): This is a non-interventional, cross-sectional, questionnaire based telephonic study which included consecutive AIRD patients on tofacitinib co-treatment. Data related to the AIRD subset, disease modifying anti rheumatic drugs (DMARDs) including glucocorticoids and comorbidities, was collected from 7 rheumatology centers across Karnataka during the second wave of COVID-19 pandemic. The information about COVID-19 occurrence and COVID-19 vaccination was recorded. Result(s): During the study period (June-July 2021), 335 AIRD patients (80.6% female) on treatment with tofacitinib were included. The mean duration of tofacitinib use was 3.4 +/- 3.1 months. Thirty-six (10.75%) patients developed COVID-19. Diabetes mellitus P = 0.04 (OR 2.60 [1.13-5.99]) was identified as a risk factors for COVID-19 in our cohort. Almost half of our cohort was COVID-19 vaccinated with at least one dose, with resultant decline in incidence of COVID-19 (OR 0.15 [0.06-0.39]) among the vaccinated. Recovery among COVID-19 infection group was 91.2%. Conclusion(s): The AIRD patients on co-treatment with tofacitinib had a higher incidence of COVID-19 than the general population during the same time period. Diabetes mellitus was identified as an independent risk factor in our cohort. COVID-19 vaccinated patients contracted COVID-19 at a significantly lesser rate than the non-vaccinated patients.
ABSTRACT
Background: The differential influence and outcome of various risk factors on occurrence of COVID-19 among patients with autoimmune rheumatic diseases (AIRD) during different COVID-19 peaks is underreported. Aim(s): To assess the impact and outcome of conventional risk factors, immunosuppressants and comorbidities on the risk of COVID-19 among AIRD patients during the first two COVID-19 peaks. Design(s): Prospective, non-interventional longitudinal cohort study. Method(s): This is a subset of the KRA COVID19 cohort undertaken during the initial wave of COVID-19 (W1) (Apr-Dec 2021);and the 2nd-wave (W2) (Jan-Aug 2021). Data collected included description of AIRD subsets, treatment characteristics, comorbidities and COVID-19 occurrence. Risk factors associated with mortality were analyzed. The incidence rate was compared with that of the general population in the same geographic region. Result(s): AIRD patients (n = 2969) had a higher incidence of COVID-19 in the W2 (7.1%) than in the W1 (1.7%) as compared to the general population (Government bulletin). Age (P < 0.01) and duration of AIRD (P < 0.001) influenced COVID-19 occurrence in W2 while major disease subsets and immunosuppressants including glucocorticoids did not. The W2 had lower HCQ usage (aRR-0.81) and comorbidities like hypertension (aRR-0.54) and pre-existing lung disease (aRR-0.38;0.19-0.75) compared to W1. Older age (aRR-1.11) and coexistent diabetes mellitus (aRR 6.74) were independent risk factors associated with mortality in W2. Conclusion(s): We report 1.7 times higher occurrence and no influence of major disease subsets or immunosuppressants including glucocorticoids on COVID 19. Age and diabetes were independent risk factors for mortality.
ABSTRACT
Objectives: This study was conducted to describe the use of tofacitinib in severe and critical Coronavirus disease -2019 (COVID-19), and to explore the association of drug initiation time with survival. Method(s): This was a retrospective chart review of inpatients with severe or critical COVID-19 at a tertiary care hospital, who received generic tofacitinib for at least 48 hours. The baseline demographics, comorbidities, treatment, adverse effects and outcomes (i.e. mortality at day 28) were analysed. The severity of COVID-19 was categorised as per WHO classification. Patients were further grouped based on median duration of symptomatic illness prior to tofacitinib administration, as early or late initiation groups. Result(s): Forty-one patients [(85.4% males), mean age 52.9 +/- 12.5 years], were studied. 65.9% (n = 27) of patients had severe COVID-19, while 34.1% (n = 14) were critically ill. Death occurred in 36.6% patients (n = 15). The median time to prescription of tofacitinib was 13 (9.50, 16.0) days of symptom onset. Tofacitinib was initiated early (8-13 days) in 56.1% of patients (n = 23), while the remaining received it beyond day 14 of symptom onset (late initiation group). The proportion of survivors was significantly higher in the early initiation group (21/23, 91.3%) compared to the late group (5/18, 27.8%) (P < 0.0001). Among severe COVID-19 patients, 100% and 62.5% of the patients were survivors among early and late initiation groups respectively (P < 0.01). In the critical COVID-19 patients, 50% were alive on day 28 in the early group while all died in the hospital in the late initiation group (P = 0.06). Multivariate logistic regression adjusted for age, presence of diabetes mellitus (DM) and illness duration prior to hospitalisation demonstrated higher odds of survival (AOR-19.3, 95% C.I. 2.57, 145.2) in the early initiation group, compared to the late initiation group. Conclusion(s): Early initiation of tofacitinib in severe and critical COVID-19 has potential to improve survival odds. (Table Presented).