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Abstract Number: 2615

Prevalence of and Factors Associated with Developing Long COVID Among Patients with Autoimmune Rheumatic Diseases: A Retrospective Cohort Analysis of National U.S. Data

Namrata Singh1, Jerrod Anzalone2, Lesley Jackson3, Sandra Safo4, Zachary Butzin-Dozier5, Kaleb Michaud6, Holland Stevenson6, Maria I. ("Maio") Danila7, Jasvinder Singh8 and Rena Patel9, 1University of Washington, Bellevue, WA, 2University of Nebraska Medical Center, Omaha, 3University of Alabama at Birmingham, Birmingham, AL, 4University of Minnesota, Minneapolis, MN, 5University of California Berkeley School of Public Health, Berkeley, CA, 6University of Nebraska Medical Center, Omaha, NE, 7University of Alabama at Birmingham (UAB), Birmingham VA Medical Center, Birmingham, AL, 8Baylor College of Medicine, Birmingham, AL, 9University of Alabama at Birmingham, Birmingham

Meeting: ACR Convergence 2024

Keywords: autoimmune diseases, COVID-19, Epidemiology

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Session Information

Date: Monday, November 18, 2024

Title: Abstracts: Infection-related Rheumatic Disease

Session Type: Abstract Session

Session Time: 3:00PM-4:30PM

Background/Purpose: Patients with Autoimmune Rheumatic Diseases (AIRDs) are at higher risk of severe COVID-19 outcomes, with greater risk among those with multiple comorbidities, using specific medications (rituximab), or with active disease. However, little is known about prevalence of or factors associated with Long COVID among patients with AIRDs.

Methods: This retrospective cohort study used electronic health record (EHR) data from the National COVID Cohort Collaborative (N3C) to study the association between AIRD and Long COVID among patients with first incident COVID-19 infection between October 2021 and March 2023 with follow-up through March 2024. We defined the primary outcome of developing Long COVID with ICD-10 code U09.9 or a Long COVID clinic visit documented from day 30 to day 365 after index COVID-19 infection.

We defined the primary exposure of AIRD using ≥2 AIRD diagnostic codes for various AIRD types (e.g., rheumatoid arthritis, polymyalgia rheumatica, spondyloarthritis, SLE, polymyositis/dermatomyositis, systemic sclerosis, and systemic vasculitis) before index COVID-19 infection. We compared patients with AIRD to patients without AIRD in a propensity score matched cohort (1:1 on age, sex, race/ethnicity, data partner site) using multivariable Cox regression modeling. We also adjusted for tobacco/substance usage, comorbidity burden, SARS-CoV-2 variant-dominant periods, acute COVID-19 severity, COVID-19 reinfections, COVID-19 vaccinations, and data partner site. In secondary analyses, we explored additional associations of AIRD medications (glucocorticoids, non-biologic disease modifying anti-rheumatic drugs [DMARDs], bDMARDs, rituximab, tsDMARDs, and other immunosuppressives [e.g., azathioprine]) and AIRD type with Long COVID.

Results: In our matched cohort of 135,442 patients, 67,721 (50%) were patients with AIRD, noting good balance between AIRD and non-AIRD patients (Table 1). We observed Long COVID in 2.1% of total patients, including 2.8% among AIRD and 1.4% among non-AIRD patients (p< 0.001). After adjusting, AIRD patients had a 62% increased risk of Long COVID compared to non-AIRD patients (aHR 1.62, 95% CI 1.50-1.76; Figure 1). Among patients with AIRD, SARS-CoV-2 infection during the Delta-dominant variant period, having reinfection(s), higher acute COVID-19 severity, having pulmonary disease, obesity, being exposed to rituximab, glucocorticoids, or other immunosuppressive medications were associated with an increased risk of Long COVID (Figure 2). No differences in risks of Long COVID were observed between AIRD types.

Conclusion: We observed an increased risk of developing Long COVID among AIRD patients compared to non-AIRD patients. The development of Long COVID in AIRD patients was strongly associated with having severe index COVID-19 infection, concomitant pulmonary disease, and use of rituximab and glucocorticoids. These data point to the need to mitigate potential risk factors associated with developing Long COVID among AIRD patients to minimize the long-term impact of COVID-19 infection in these patients.

Supporting image 1

Table 1. Descriptive Statistics for Propensity Score Matched Patients with and without AIRD with COVID_19 Infection Documented Between October 2021 and March 2023

Supporting image 2

Figure 1. Multivariable Cox Proportional Hazards for Long COVID in a Matched AIRD and non-AIRD Control Cohort of Patients with COVID_19 Infection Documented Between October 2021 and March 2023

Supporting image 3

Figure 2. Multivariable Cox Proportional Hazards for Long COVID among patients with AIRD with with COVID_19 Infection Documented Between October 2021 and March 2023


Disclosures: N. Singh: None; J. Anzalone: None; L. Jackson: None; S. Safo: None; Z. Butzin-Dozier: None; K. Michaud: None; H. Stevenson: None; M. Danila: AbbVie/Abbott, 2, Pfizer, 5; J. Singh: Adaptimmune Therapeutics, 2, Adept Field Solutions, 2, Aebona Pharmaceuticals, 11, Amarin, Viking and Moderna pharmaceuticals, 11, Atai life sciences, Kintara therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Ad, 11, Charlotte's Web Holdings, 11, Clinical Care options, 2, Enzolytics Inc, 11, Fidia, 2, Focus forward, 2, GeoVax Labs, 11, Intuitive Surgical Inc./Philips Electronics North America, 12, food and beverage payments, Jupiter Life Science, 2, MedIQ, 2, Medscape, 2, Medusas, 2, Navigant consulting, 2, Pieris Pharmaceuticals, 11, PK Med, 2, Practice Point communications, 2, Putnam associates, 2, ROMTech, Atheneum, Clearview healthcare partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals/DINORA, Frictionless Solution, 2, Schipher, 2, Seres Therapeutics, 11, speaker’s bureau of Simply Speaking, 6, Tonix Parmaceuticals, 11, Trio Health, 2, Two Labs Inc, 2, UBM LLC, 2, WebMD, 2, Zimmer Biomet Holdings, 5; R. Patel: None.

To cite this abstract in AMA style:

Singh N, Anzalone J, Jackson L, Safo S, Butzin-Dozier Z, Michaud K, Stevenson H, Danila M, Singh J, Patel R. Prevalence of and Factors Associated with Developing Long COVID Among Patients with Autoimmune Rheumatic Diseases: A Retrospective Cohort Analysis of National U.S. Data [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/prevalence-of-and-factors-associated-with-developing-long-covid-among-patients-with-autoimmune-rheumatic-diseases-a-retrospective-cohort-analysis-of-national-u-s-data/. Accessed .
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All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

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