Individuals with autoimmune diseases appear to be at increased risk for COVID-19, primarily due to glucocorticoid use, according to findings from a systematic review and meta-analysis.
“Our meta-regression analysis demonstrated that glucocorticoid use prior to COVID-19 significantly contributed to the disease prevalence,” the researchers wrote.
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The meta-analysis, which included 62 observational studies comprising 319,025 patients with autoimmune diseases, showed that the prevalence of COVID-19 was 0.011, which was significantly higher than among control patients. Prior glucocorticoid use was significantly associated with the increased COVID-19 risk, according to meta-regression analysis.
According to a subgroup analysis, the prevalaence of COVID-19 was lower among patients with inflammatory bowel disease than among patients with rheumatic disease, systemic lupus erythematosus, Sjögren syndrome, or systemic sclerosis. According to the researchers, the higher comparative prevalence may be attributable to the higher use of glucocorticoids among patients with the latter 4 conditions.
An assessment of 65 studies involving 2766 patients with autoimmune diseases who had contracted COVID-19 showed that clinical outcomes were not significantly worse compared with patients without autoimmune diseases. Among patients with an autoimmune disease and COVID-19, the rate of hospitalization was 0.35 and the rate of mortality was 0.066.
Glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and biologic or targeted synthetic DMARDs (b/tsDMARDs)–csDMARDs combination therapy significantly increased the risk of hospitalization and mortality due to COVID-19, the researchers reported. Older age and comorbidities, such as hypertension or diabetes, were also linked with severe COVID-19 outcomes among patients with autoimmune diseases.
Meanwhile, b/tsDMARDs monotherapy—in particular, antitumor necrosis factor agents—reduced the risk of severe COVID-19 outcomes.
“Our meta-analysis provides evidence that b/tsDMARDs monotherapy can be safely used during the pandemic,” the researchers advised.
Akiyama S, Hamdeh S, Micic D, Sakuraba A. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis. Published online October 13, 2020. doi:10.1136/annrheumdis-2020-218946