Prevalence and anti-rheumatic drugs on the clinical outcome of COVID-19 in autoimmune rheumatic diseases

ABSTRACT

Purpose: The pandemic of novel coronavirus disease 2019 (COVID-19) caused by the emerging severe acute respiratory syndrome coronavirus 2 (sars-cov- 2) has become a global health crisis (WHO, 2020b), leading to large number of infections and deaths. Autoimmune rheumatic diseases (ARD) are characterized by immune dysfunction and more susceptible to infection. The prevalence of COVID-19 in ARD patients was estimated by means of meta-analysis, and the effect of the use of anti-rheumatic drugs on the clinical outcome of ARD patients with COVID-19 was investigated. Method(s) Cross-sectional investigations and case series on ARD and COVID-19 published by CBM, CNKI, China Science and Technology Journal Database, Wan Fang Data, PubMed, Embase, Web of Science, Cochrane Library and Medline from its establishment to June 26, 2022 were searched. Random effects model was used to pool data. Heterogeneity and risk of bias was examined with I-squared index (I2) statistic. Egger tests were used for the evaluation of potential publication bias (STATA v.12.0). Result(s) A total of 65 studies comprising 135 515 patients were identified. Overall prevalence of COVID-19 in ARD patients was 5.4% (95%CI 4.3%-6.5%). The hospitalisation rate due to COVID-19 was 35.9% (95% CI 28.3%-43.4%). The hospitalisation rates for ARD patients diagnosed with COVID-19 who received glucocorticoid was 35.9% (95%CI 31.4%-40.4%). The rates of hospitalisation in patients who received hydroxychloroquine was 39.9% (95%CI 34.5%-45.3%), and in patients who received biologic disease-modifying anti-rheumatic drugs (b-DMARD) was 38.1% (95%CI 33.6%-42.5%), which were both higher than total hospitalisation. The mortality due to COVID-19 in patients with ARD was 6.0% (95% CI 5.1%-6.8%). The mortality in ARD patients diagnosed with COVID-19 who received glucocorticoid was 5.3% (95%CI 4.3%-6.2%), and in patients who received b-DMARD was 5.8% (95%CI 4.9%-6.7%). Mortality rates for patients who received hydroxychloroquine was 5.2% (95%CI 4.2%-6.2%) (Figure 1). Conclusion(s) Patients with ARD had a higher risk of COVID-19. Use of glucocorticoids decrease mortality in these patients suffered from COVID-19 infection. Though patients had a higher hospitalisation rates but lower mortality among patients prescribed b-DMARD or hydroxychloroquine. (Figure Presented).