Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis.
Ann Rheum Dis
; 80(3): 384-391, 2021 03.
Article
in English
| MEDLINE | ID: covidwho-868283
ABSTRACT
OBJECTIVES:
The prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases who are frequently treated with disease modifying therapies remains poorly understood. This meta-analysis aims to assess the prevalence and clinical outcomes of COVID-19 in autoimmune diseases.METHODS:
Electronic databases were searched for observational and case-controlled studies. We sorted medications into glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic or targeted synthetic DMARDs (b/tsDMARDs), which was also divided into monotherapy and b/tsDMARDs-csDMARDs combination therapy.RESULTS:
We analysed 62 observational studies with a total of 319 025 patients with autoimmune diseases. The prevalence of COVID-19 was 0.011 (95% CI 0.005 to 0.025). Meta-analysis of seven case-controlled studies demonstrated that the risk of COVID-19 in autoimmune diseases was significantly higher than in control patients (OR 2.19, 95% CI 1.05 to 4.58, p=0.038). Meta-regression analysis showed glucocorticoids were significantly associated with the risk of COVID-19. For clinical outcomes, we assessed 65 studies with 2766 patients with autoimmune diseases diagnosed with COVID-19. The rates of hospitalisation and mortality were 0.35 (95% CI 0.23 to 0.50) and 0.066 (95% CI 0.036 to 0.12), respectively. Glucocorticoids, csDMARDs and b/tsDMARDs-csDMARDs combination therapy increased the risk of these outcomes, whereas b/tsDMARDs monotherapy, particularly antitumour necrosis factor agents, were associated with a lower risk of hospitalisation and death.CONCLUSIONS:
Our meta-analysis demonstrated that patients with autoimmune diseases had an increased risk of COVID-19, primarily attributed to glucocorticoid use. b/tsDMARDs monotherapy was associated with a lower risk of severe COVID-19 suggesting its safety in the COVID-19 pandemic.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Arthritis, Rheumatoid
/
Autoimmune Diseases
/
Antirheumatic Agents
/
COVID-19
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
/
Reviews
/
Systematic review/Meta Analysis
Topics:
Long Covid
Limits:
Humans
Language:
English
Journal:
Ann Rheum Dis
Year:
2021
Document Type:
Article
Affiliation country:
Annrheumdis-2020-218946
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