COVID-19 in PATIENTS with GIANT CELL ARTERITIS

ABSTRACT

Background: Patients with giant cell arteritis (GCA) represent a fragile population with an increased infection risk. In a recent study1 older age, a higher number of comorbidities, higher disease activity, and prednisolone ≥10 mg qd were associated with worse COVID-19 outcomes. Objectives: We aimed to evaluate the frequency and severity of COVID-19 in a well-defned GCA cohort. Methods: We reviewed medical records of histologically and/or by imaging proven GCA patients diagnosed between September 2011 and February 2020 at our secondary/tertiary center and followed during the COVID-19 pandemic between March 2020 and December 2021 (22 months). Descriptive statistics was used to analyze the studied population. Results: Of 314 GCA patients diagnosed for the frst time during a 102-month period, 49 patients died before March 2020. Of the remaining 265 patients (69.4% females), SARS-CoV-2 infection was proven by PCR test in 39 (14.7%) patients (74.2% females, mean (SD) age at infection 76.2 (±9.6 years), 13 (33.3%) with large vessel GCA and 16 with cranial limited GCA). At the time of SARS-Cov-2 infection GCA was in a stable remission in 38 patients (13 without therapy, 10 on steroids alone, 9 on lefunomide monotherapy, 6 on steroids plus lefunomide (10 or 20 mg qd), 1 on ustekinumab;mean prednisolone equivalent dose of 4.6 mg qd) and relapsed in one patient 6 weeks earlier (predni-solone 30 mg plus lefunomide). Data on clinical manifestations of COVID-19 were available for 33 (84.6%) patients and are presented in Table 1, part A. Twenty-nine/39 (74.4%) patients had mild COVID-19 and were symptomatically treated at home, while 10 patients had severe infection (defned as a need of hospitalization and/or death), and one of those patients died due to COVID-19. One patient developed a transient neurologic ischemic attack related to COVID-19. Table 1, part B shows differences in GCA demographic and treatment at the time of mild vs. severe infection. We found no differences in gender, age, GCA type and GCA treatment between those with mild vs. severe COVID. Three patients developed COVID-19 after receiving two doses of anti-COVID vaccine (1.4% breakthrough rate). Overall, of 257 GCA patients eligible for vaccination, 210 (81.7%) were vaccinated by the end of December 2021. Conclusion: A quarter of our GCA patients had severe COVID-19. Low doses of glucocorticoids and treatment with lefunomide were not associated with severe COVID-19 course in our cohort.