Factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy: results from the COVID-19 Global Rheumatology Alliance physician-reported registry
Su‐Ann Yeoh, Milena Gianfrancesco, Saskia Lawson‐Tovey, Kimme L Hyrich, Anja Strangfeld, Laure Gossec, Loreto Carmona, Elsa F Mateus, Martin Schäfer, Christophe Richez, É. Hachulla, Marie Holmqvist, Carlo Alberto Scirè, Hanns‐Martin Lorenz, Reinhard Voll, Rebecca Hasseli, Arundathi Jayatilleke, Tiffany Hsu, Kristin M. D’Silva, Víctor R. Pimentel-Quiroz, Mónica Vázquez-Del Mercado, Samuel Katsuyuki Shinjo, Edgard Torres dos Reis Neto, Laurindo Ferreira da Rocha, Ana Carolina de Oliveira e Silva Montandon, Guillermo Pons‐Estel, Sofía Ornella, Maria Eugenia D’Angelo Exeni, E. Velozo, Paula Jordan, Emily Sirotich, Jonathan S. Hausmann, Jean W. Liew, Lindsay Jacobsohn, Monique Gore‐Massy, Paul Sufka, Rebecca Grainger, Suleman Bhana, Zachary S. Wallace, Philip C. Robinson, Jinoos Yazdany, Pedro Machado
Abstract
OBJECTIVES: To investigate factors associated with severe COVID-19 in people with idiopathic inflammatory myopathy (IIM). METHODS: Demographic data, clinical characteristics and COVID-19 outcome severity of adults with IIM were obtained from the COVID-19 Global Rheumatology Alliance physician-reported registry. A 3-point ordinal COVID-19 severity scale was defined: (1) no hospitalisation, (2) hospitalisation (and no death) and (3) death. ORs were estimated using multivariable ordinal logistic regression. Sensitivity analyses were performed using a 4-point ordinal scale: (1) no hospitalisation, (2) hospitalisation with no oxygen (and no death), (3) hospitalisation with oxygen/ventilation (and no death) and 4) death. RESULTS: Of 348 patients, 48% were not hospitalised, 39% were hospitalised (and did not die) and 13% died. Older age (OR=1.59/decade, 95% CI 1.31 to 1.91), high disease activity (OR=3.50, 95% CI 1.25 to 9.83; vs remission), ≥2 comorbidities (OR=2.63, 95% CI 1.39 to 4.98; vs none), prednisolone-equivalent dose >7.5 mg/day (OR=2.40, 95% CI 1.09 to 5.28; vs no intake) and exposure to rituximab (OR=2.71, 95% CI 1.28 to 5.72; vs conventional synthetic disease-modifying antirheumatic drugs only) were independently associated with severe COVID-19. In addition to these variables, in the sensitivity analyses, male sex (OR range: 1.65-1.83; vs female) was also significantly associated with severe outcomes, while COVID-19 diagnosis after 1 October 2020 (OR range: 0.51-0.59; vs on/before 15 June 2020) was significantly associated with less severe outcomes, but these associations were not significant in the main model (OR=1.57, 95% CI 0.95 to 2.59; and OR=0.61, 95% CI 0.37 to 1.00; respectively). CONCLUSIONS: This is the first large registry data on outcomes of COVID-19 in people with IIM. Older age, male sex, higher comorbidity burden, high disease activity, prednisolone-equivalent dose >7.5 mg/day and rituximab exposure were associated with severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with IIM.