Characteristics Associated with Poor COVID-19 Outcomes in People with Systemic Lupus Erythematosus (SLE): Data from the COVID-19 Global Rheumatology Alliance (GRA)

Manuel Ugarte-Gil¹, Graciela Alarcn², Andrea Seet³, Zara Izadi³, Ali Duarte-Garcia⁴, Cristina Reategui-Sokolova⁵, Ann Clarke⁶, Leanna Wise⁷, Guillermo Pons-Estel⁸, Maria José Santos⁹, Sasha Bernatsky¹⁰, Sandra Lúcia Ribeiro¹¹, Samar Al Emadi¹², Jeffrey Sparks¹³, Tiffany Hsu¹⁴, Kristin D'Silva¹⁵, Naomi Patel¹⁵, Emily Gilbert¹⁶, Maria Valenzuela-Almada¹⁷, Andreas Jnsen¹⁸, Gianpiero Landolfi¹⁹, Micaela Fredi²⁰, Tiphaine Goulenok²¹, Mathilde Devaux²², Xavier Mariette²³, Viviane Queyrel²⁴, Vasco C Romão²⁵, Graça Sequeira²⁶, Rebecca Hasseli²⁷, Bimba Franziska Hoyer²⁸, Reinhard Voll²⁹, Christof Specker³⁰, Roberto Baez³¹, Vanessa Castro Coello³², Edgard Neto³³, Gilda Ferreira³⁴, Odirlei Andre Monticielo³⁵, Emily Sirotich³⁶, Jean Liew³⁷, Jonathan Hausmann³⁸, Paul Sufka³⁹, Rebecca Grainger⁴⁰, Suleman Bhana⁴¹, Wendy Costello⁴², Zachary Wallace⁴³, Lindsay Jacobsohn⁴⁴, Anja Strangfeld⁴⁵, Elsa Frazão Mateus⁴⁶, Kimme Hyrich⁴⁷, Laure Gossec⁴⁸, Loreto Carmona¹, Saskia Lawson-Tovey⁴⁷, Lianne Kearsley-Fleet⁴⁹, Martin Schaefer⁵⁰, Pedro Machado⁵¹, Philip Robinson⁵², Milena Gianfrancesco³ and Jinoos Yazdany³, ¹Hospital Guillermo Almenara Irigoyen, Essalud/Universidad Científica del Sur, Lima, Peru, ²University of Alabama at Birmingham, Birmingham, AL, ³University of California San Francisco, San Francisco, CA, ⁴Mayo Clinic, Rochester, MN, ⁵Hospital Guillermo Almenara Irigoyen, Lima, Peru, ⁶University of Calgary, Calgary, AB, Canada, ⁷LAC+USC/Keck Medicine of USC, Pasadena, CA, ⁸Centro Regional de Enfermedades Autoinmunes y Reumaticas (CREAR), Rosario, Argentina, ⁹Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, ¹⁰McGill University, Montréal, QC, Canada, ¹¹Universidade Federal do Amazonas, Amazonas, Brazil, ¹²Hamad medical corporation, Doha, Qatar, ¹³Brigham and Women's Hospital, Boston, MA, ¹⁴Brigham and Women's Hospital, Jamaica Plain, MA, ¹⁵Massachusetts General Hospital, Boston, MA, ¹⁶Mayo Clinic, Jacksonville, FL, ¹⁷Division of Rheumatology, Mayo Clinic, Rochester, MN, ¹⁸Lund University, Lund, Sweden, ¹⁹Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy, ²⁰Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy, ²¹Internal Medicine Department, Bichat Claude Bernard Hospital, Paris, France, ²²Service de Médecine Interne, CHI Poissy Saint Germain, Poissy, France, ²³Université Paris- Saclay, Rheumatology, Paris, France, ²⁴University Hospital of Nice, Nice, France, ²⁵Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET); Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal, ²⁶Centro Hospitalar Universitário do Algarve, Unidade de Faro, Faro, Portugal, ²⁷Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany., Bad Nauheim, Germany, ²⁸Universittsklinikum Schleswig-Holstein, Kiel, Germany, ²⁹Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany, ³⁰Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen, Germany, ³¹Hospital Francisco Lopez Lima, General Roca, Rio Negro, Argentina, ³²Sanatorio Güemes, Buenos Aires, Argentina, ³³UNIFESP, São Paulo, Brazil, ³⁴Federal University of Minas Gerais, Belo Horizonte, Brazil, ³⁵Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ³⁶McMaster University, Hamilton, ON, Canada, ³⁷Boston University, Boston, MA, ³⁸Boston Children's Hospital / Beth Israel Deaconess Medical Center, Cambridge, MA, ³⁹HealthPartners, Eagan, MN, ⁴⁰University of Otago, Wellington, New Zealand, ⁴¹Crystal Run Health, Montvale, NJ, ⁴²Irish Children's Arthritis Network, Bansha, Ireland, ⁴³Massachusetts General Hospital, Newton, MA, ⁴⁴University of California San Francisco, Antioch, CA, ⁴⁵Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany, ⁴⁶Liga Portuguesa Contra as Doenças Reumáticas (LPCDR), Lisbon, Portugal, ⁴⁷University of Manchester, Manchester, United Kingdom, ⁴⁸Sorbonne Université; APHP, Rheumatology Department, Pitié-Salpêtrière Hospital, Paris, France, ⁴⁹Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom, ⁵⁰German Rheumatism Research Center, Berlin, Germany, ⁵¹Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom, ⁵²Faculty of Medicine, The University of Queensland, Herston, Australia

Meeting: ACR Convergence 2021

Keywords: COVID-19, Outcome measures, Systemic lupus erythematosus (SLE)

Session Information

Date: Sunday, November 7, 2021

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster II: Manifestations (0855–0896)

Session Type: Poster Session B

Session Time: 8:30AM-10:30AM

Background/Purpose: Preliminary data in people with SLE suggested that disease activity as well as SLE treatment at time of COVID-19 acquisition impact COVID-19 outcomes over and above other known risk factors. We assessed characteristics associated with poor outcomes in a global population of people with SLE and COVID-19.

Methods: People with SLE reported in the COVID-19 Global Rheumatology Alliance (GRA) physician-reported registry from March 24^th 2020 to April 12^th 2021 were included. Variables collected included age, gender, region [Europe, North America, South America and other (Africa, Asia and Australia)], comorbidities (chronic renal disease, cardiovascular disease, and the number of other comorbidities), physician global assessment of disease activity, calendar period, glucocorticoid dose, and SLE treatment at the time of COVID diagnosis. SLE treatment was categorized into five groups: antimalarials only (reference), no SLE drugs, non-biologic immunosuppressant (IS) monotherapy, biologics/target synthetic IS, and combination IS therapy. An ordinal outcome was defined as: 1) not hospitalized, 2) hospitalized without supplementary oxygen or with non-invasive ventilation, 3) hospitalized with mechanical ventilation/extracorporeal membrane oxygenation and 4) death. We constructed a multivariable ordinal logistic regression model to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity.

Results: 1734 patients were included; 1567 (90.4%) were female, median age was 44.3 (SD: 14.3) years. A total of 1291 (74.5%) patients were not hospitalized; 148 (8.5%) patients were hospitalized without oxygen or with non-invasive ventilation, 195 (11.2%) patients were hospitalized with mechanical ventilation/extracorporeal membrane oxygenation and 100 (5.6%) died. In our multivariable model, more severe COVID-19 outcomes were seen in older patients (odds ratio, OR=1.03 per year), males (OR =1.74), patients outside Europe and North and South America (OR=3.77), patients on prednisone (0-5 mg/d OR=1.87, 5-10 mg/d OR=2.46, and >10 mg/d OR=2.32), no SLE therapy (OR =2.05), chronic renal disease (OR =3.21), cardiovascular disease (OR =1.64), the number of other comorbidities (OR=1.51) and moderate and high disease activity (OR =1.78 and OR=4.18, respectively). There was evidence of a calendar period effect, with worse outcomes in those with a COVID diagnosis earlier in the pandemic (before June 15, 2020); these data are summarized in Table 1.

Conclusion: These results demonstrate patterns similar to the general rheumatic disease population, and underscore the importance of controlling disease activity in people

with SLE patients during the COVID-19 pandemic.

Disclosures: M. Ugarte-Gil, Pfizer, 5, Janssen, 5; G. Alarcn, None; A. Seet, None; Z. Izadi, None; A. Duarte-Garcia, None; C. Reategui-Sokolova, Jannsen, 5; A. Clarke, AstraZeneca, 2, GSK, 6, BMS, 2, Exagen Diagnostics, 2; L. Wise, None; G. Pons-Estel, Pfizer, 1, 6, Janssen, 6, Janssen, 5, GSK, 1, 6, Sanofi, 1; M. José Santos, Abbvie, 6, Novartis, 6, Pfizer, 6, Roche, 6; S. Bernatsky, None; S. Ribeiro, None; S. Al Emadi, None; J. Sparks, Bristol-Myers Squibb, 2, 5, Amgen, 5, Gilead, 2, Inova, 2, Janssen, 2, Optum, 2, Pfizer, 2; T. Hsu, None; K. D'Silva, None; N. Patel, None; E. Gilbert, None; M. Valenzuela-Almada, None; A. Jnsen, None; G. Landolfi, None; M. Fredi, None; T. Goulenok, None; M. Devaux, None; X. Mariette, GlaxoSmithKline, 2, BMS, 2, Servier, 2, Janssen, 2, Novartis, 2, Pfizer, 2, UCB, 2; V. Queyrel, boehringer-ingelheim, 6; V. Romão, None; G. Sequeira, None; R. Hasseli, Pfizer, Medac, Amgen, Galapagos, Novartis, Roche, Takeda, BMS, Janssen, 1, 5; B. Hoyer, Pfizer, 1, 6, Abbvie, 6, UCB, 6; R. Voll, None; C. Specker, AbbVie, 1, 6, Boehringer, 1, 6, Chugai, 2, 6, GSK, 1, 6, Lilly, 6, MSD, 6, Novartis, 1, 6, Pfizer, 6, Roche, 6, Sanofi, 6, Sobi, 1, 6; R. Baez, None; V. Castro Coello, None; E. Neto, GlaxoSmithKline (GSK), 6, Novartis, 6, BracePharma, 6; G. Ferreira, None; O. Andre Monticielo, GSK, 6, GSK, 2; E. Sirotich, None; J. Liew, None; J. Hausmann, Novartis, 2, Biogen, 2, Pfizer, 2; P. Sufka, Wiley Publishing, 6; R. Grainger, Pfizer New Zealand, 6, 12, support to travel to conference, Jansenn Autralia, 6, 12, travel to symposia, AbbVie New Zealand, 6, Cornerstones, 6, novartis, 1; S. Bhana, Amgen, 1, Novartis, 1, Horizon, 1, Pfizer, 1, AbbVie, 1; W. Costello, None; Z. Wallace, Bristol-Myers Squibb, 5, Principia/Sanofi, 5, Viela Bio, 2, MedPace, 2; L. Jacobsohn, None; A. Strangfeld, Pfizer, 6, Roche, 6, MSD, 6, BMS, 6, Abbvie, 6, Celltrion, 6; E. Frazão Mateus, Boehringer Ingelheim, 6, Pfizer, 5, 12, Non-financial, Lilly Portugal, 5, Sanofi, 5, AbbVie, 5, Novartis, 5, Grünenthal. SA., 5, MSD, 5, Celgene, 5, Medac, 5, Janssen-Cilag, 5, Pharmakern, 5, GAfPA, 5; K. Hyrich, Abbvie, 6, Pfizer, 5, BMS, 5; L. Gossec, AbbVie, 2, 5, Amgen, 2, 5, Bristol-Myers Squibb, 2, 6, Celgene, 2, 5, Eli Lilly, 2, 5, Janssen, 2, 5, MSD, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, Roche, 2, 5, Sanofi, 2, 5, UCB, 2, 5; L. Carmona, None; S. Lawson-Tovey, None; L. Kearsley-Fleet, None; M. Schaefer, None; P. Machado, Abbvie, 6, BMS, 6, Celgene, 6, Eli Lilly, 2, Janssen, 2, MSD, 6, Galapagos, 6, Novartis, 2, 6, Pfizer, 6, Roche, 6, UCB, 2, 6, Orphazyme, 5, 6; P. Robinson, Abbvie, 5, UCB Pharma, 5, Novartis, 5, 6, Gilead, 6, Eli Lilly, 6, Pfizer Inc, 5, 6, Janssen, 5, 6, Roche, 6, 12, The University of Queensland, 3; M. Gianfrancesco, None; J. Yazdany, Pfizer, 2, Astra Zeneca, 5, Eli Lilly, 2, University of California, San Francisco, 3.

To cite this abstract in AMA style:

Ugarte-Gil M, Alarcn G, Seet A, Izadi Z, Duarte-Garcia A, Reategui-Sokolova C, Clarke A, Wise L, Pons-Estel G, José Santos M, Bernatsky S, Ribeiro S, Al Emadi S, Sparks J, Hsu T, D'Silva K, Patel N, Gilbert E, Valenzuela-Almada M, Jnsen A, Landolfi G, Fredi M, Goulenok T, Devaux M, Mariette X, Queyrel V, Romão V, Sequeira G, Hasseli R, Hoyer B, Voll R, Specker C, Baez R, Castro Coello V, Neto E, Ferreira G, Andre Monticielo O, Sirotich E, Liew J, Hausmann J, Sufka P, Grainger R, Bhana S, Costello W, Wallace Z, Jacobsohn L, Strangfeld A, Frazão Mateus E, Hyrich K, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Machado P, Robinson P, Gianfrancesco M, Yazdany J. Characteristics Associated with Poor COVID-19 Outcomes in People with Systemic Lupus Erythematosus (SLE): Data from the COVID-19 Global Rheumatology Alliance (GRA) [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/characteristics-associated-with-poor-covid-19-outcomes-in-people-with-systemic-lupus-erythematosus-sle-data-from-the-covid-19-global-rheumatology-alliance-gra/. Accessed .

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