Background/Purpose: The risk of COVID-19 infection among patients with Systemic Lupus Erythematosus (SLE) is poorly understood. Patients with SLE often take medications which modulate the immune system, and some were of interest as possible therapies for COVID-19. It is not fully understood if taking these medications may be associated with an increased or decreased risk of contracting COVID-19. This survey sought to investigate the rate of COVID-19 infection among our patients with SLE, identify disease severity among infected patients, and identify any correlation between ongoing treatment and the diagnosis of COVID-19.

Methods: We identified all patients with SLE seen in the Rheumatology clinic between January 2018 and March 2020. Patients were contacted via telephone from June 2020 through August 2020 to complete a questionnaire. Data were collected by chart review and by a telephone questionnaire. We recorded data on patient demographics, medication regimen, COVID-19 diagnosis and complications, and social distancing practices. A logistic regression was performed to identify possible risk factors for being diagnosed with COVID-19.

Results: 245 patients with SLE were identified. 129 (52%) completed the telephone questionnaire. The COVID-19 status was known for 137 patients, either through chart review or by the telephone survey. The most commonly used medications were hydroxychloroquine (82.2%), prednisone (45.7%), and mycophenolate mofetil (32.6%).14 (10.2%) patients were diagnosed with COVID-19. Among these patients, 4 were hospitalized, 2 received intensive care-unit level of care, and 3 died. There were no deaths attributed to active lupus in the patients that were surveyed. The odds of being diagnosed with COVID-19 were not significantly higher in patients treated with steroids (OR 1.08, 95% CI 0.36 to 3.28), hydroxychloroquine (OR 0.84, 95% CI 0.22 to 3.27), mycophenolate mofetil (OR 0.57, 95% CI 0.15 to 2.14), belimumab (OR 2.76, 95% CI 0.51 to 14.82), leflunomide (OR 3.08, 95% CI 0.30 to 31.77) or azathioprine (OR 1.01, 95% CI 0.20 to 4.94). Known contact with someone who had COVID-19 was associated with an increased risk of being diagnosed with COVID-19 (OR 7.79, 95% CI 1.43 to 42.38). The odds of contracting COVID-19 were not increased with comorbid lung disease (OR 0.61, 95% CI 0.16 to 2.31), gender (OR 1.09, 95% CI 0.12 to 8.76), smoking history (OR 1.49, 95% CI 0.43 to 5.15), age above median (47 years, OR 0.51, 95% OR 0.16 to 1.61), or weight above median (76.7 kg, OR 1.02, 95% CI 0.34 to 3.07). The median subjective disease activity score determined by the patient on a scale of 0-10 was 3.

Conclusion: Immunosuppressive treatment was not associated with increased odds of contracting COVID-19. Our infection rate of 10.2% is within the range of percentage of total Brooklyn residents testing positive for COVID-19 (3.08% – 13.97% per the New York Times New York City Coronavirus Map and Case Count database). Patients with SLE do not appear to have an elevated risk of COVID-19 compared to the general population. Surveyed patients felt that their SLE was fairly well controlled during the pandemic.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/identifying-covid-19-infection-rates-and-outcomes-in-patients-with-systemic-lupus-erythematosus/