Effects of antirheumatic drugs on prevalence and clinical outcome of COVID-19 in systemic lupus erythematosus: a meta-analysis

ABSTRACT

Purpose: Novel Coronavirus pneumonia 2019 (COVID-19) caused by the novel coronavirus severe acute respiratory syndrome (SARS) coronavirus- 2 (CoV-2) is a highly contagious infection with high morbidity and mortality1. Patients with systemic lupus erythematosus (SLE) are considered to be susceptible to coronavirus due to impaired immune function2. This study aims to systematically evaluate the prevalence of COVID-19 in SLE patients, and futher explore the impact of antirheumatic drug on the clinical outcome of COVID-19 in SLE patients. Method(s) Systematic searches of PubMed, EMBASE, Web of Science, the Cochrane Library and Medline, CNKI, CBM, China Science and Technology Journal Database and Wan Fang Data were performed. Cross-sectional investigations and case series on SLE and COVID-19 were included. Random effects model was used to pool data. Heterogeneity and risk of bias was examined with I squared index (I2) statistic and Egger tests were used for the evaluation of potential publication bias (STATA v.12.0). Result(s) A total of 14 studies comprising 5115 SLE patients and 698 COVID-19 patients were identified. Overall prevalence of COVID-19 in SLE patients was 6.7% (95%CI 4.4-9.1%). The hospitalization rate was 31.6% (95%CI 15.8%-47.3%), with the rate of 22.2% (95%CI 6.2-38.2%) of patients were admitted to ICU, and the death rate was 19.3% (95%CI 2.7%-35.9%). Eight of the studies included patients who used hydroxychloroquine as part of their treatment regimen, with 5.7% (95%CI 3.3%-8.0%) prevalence rate. The hospitalisation rates for SLE patients with COVID-19 infection who received glucocorticoid was 69.2% (95%CI 46.8%-91.6%). The rates of hospitalisation in patients who received hydroxychloroquine was 59.2% (95%CI 45.8%-72.6%), and in patients who received biologic disease-modifying anti-rheumatic drugs (b-DMARD) was 61.8% (95%CI 32.7%-90.9%). The adverse outcome rate due to COVID-19 in patients with SLE was 34.1% (95% CI 4.3%-64%). The rate of adverse outcome in SLE patients diagnosed with COVID-19 who received glucocorticoid was 22.9% (95%CI 9%-31.5%), and in patients who received hydroxychloroquine was 22.9% (95%CI 0.1%-45.7%, Figure 1). Conclusion(s) Patients with SLE had a higher risk of COVID-19. Anti-rheumatic drugs may help reduce the prevalence and overall rate of adverse outcomes of COVID-19. Figure 1.