Variation in immunosuppressant impact onsevere COVID-19 outcome: Preliminary results fromthe COVID-19 Scottish Registry of AutoimmuneRheumatic Diseases (SCAR-19)

ABSTRACT

Background/AimsThe novel infectious disease COVID-19 is associated with a widespectrum of clinical severity amongst the general population. Patientswith autoimmune rheumatic diseases (ARD) are more likely toexperience serious COVID-19 related events, although risk factorsfor such outcomes have yet to be established. In particular, the riskprofiles of specific ARD therapies are unknown.MethodsA Scottish wide registry was rapidly developed in March 2020. Clinicalcharacteristics and outcomes of infected cases were collated acrossall Scottish health boards, leveraging the Scottish Systemic VasculitisNetwork and Scottish Society for Rheumatology. Eligible patientsincluded any adult ARD patients with a confirmed (clinically or PCR)diagnosis of COVID-19. Simple descriptive statistics were employed toevaluate associations between ARD therapies and a serious COVID-19disease outcome, as defined by a requirement of invasive or noninvasive ventilation, and/or death.ResultsA total of 69 patients (59% female;mean age 65.6, SD15.5) wererecruited to the registry , 92% of which required hospitalisation. Caseswere most commonly diagnosed with rheumatoid arthritis (n = 32, 46.4%) followed by spondyloarthritis (n = 19, 27.5%) and systemicvasculitis (n = 9, 13.0%). Anti-TNF therapy (n = 8, 11.6%) andmethotrexate (n = 31, 44.9%) were the commonest biologic andconventional disease modifying drug (bDMARD and csDMARD) usedrespectively. N = 20 (29%) received background corticosteroid therapy (15.9% prednisolone >5mg, 13% prednisolone 5mg). A severeoutcome was observed in n = 25(31.9%);n = 11 required assistedventilation and n = 19 died. With the exception of Leflunomide, conventional and biologic DMARDs did not appear to confer ahigher risk for severe outcome (table 1). Of note, anti-TNF therapywas associated with a non-serious outcome (p = 0.04) and prednisolone>5mg with a serious outcome (p = 0.08). ConclusionPreliminary data from this Scotland-wide ARD COVID-19 registryevidences variation in the impact of standard ARD therapies on theseverity of COVID-19 outcome. In general, background csDMARD andbDMARD use does not appear to be a risk factor for severe outcomes.However, anti-TNF therapy may confer a favourable outcome, whileleflunomide and corticosteroids may have the opposite effect.Rheumatologists should be aware of these possible risk factors andcontinue to contribute to registries to help establish whether theseputative signals are clinically relevant.