SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Disease: A Systematic Literature Review

Richard Conway¹, Alyssa Grimshaw², Maximilian Konig³, Michael Putman⁴, Ali Duarte-Garcia⁵, Candice Low⁶, Shangyi Jin⁷, Diego Cabrera⁸, Yu Pei Eugenia Chock⁹, Berk Degirmenci¹⁰, Eimear Duff¹¹, Bugra Egeli¹², Elizabeth Graef¹³, Akash Gupta¹⁴, Patricia Harkins¹⁵, Bimba Franziska Hoyer¹⁶, Aruni Jayatilleke¹⁷, Christopher Kasia¹⁸, Aneka Khilnani¹⁹, Adam Kilian²⁰, Alfred Kim²¹, Chung Mun Alice Lin²², Laurie Proulx²³, Sebastian Sattui²⁴, Namrata Singh²⁵, Jeffrey Sparks²⁶, Herman Tam²⁷, Leslie Yingzhijie Tseng², Manuel Ugarte-Gil²⁸, Natasha Ung²⁹, Leanna Wise³⁰, Ziyi Yang³¹, Kristen Young³², Jean Liew³³, Rebecca Grainger³⁴, Zachary Wallace³⁵ and Evelyn Hsieh², ¹St. James's University Hospital, Dublin, Ireland, ²Yale School of Medicine, New Haven, CT, ³The Johns Hopkins University School of Medicine, Baltimore, MD, ⁴Medical College of Wisconsin, Brookfield, WI, ⁵Mayo Clinic, Rochester, MN, ⁶St. Vincent's University Hospital, Dublin, Ireland, ⁷Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China (People's Republic), ⁸Yale School of Medicine, Lima, Peru, ⁹Yale School of Medicine, Greenwich, CT, ¹⁰St. Elizabeth's Medical Center, Boston, MA, ¹¹St. James's Hospital, Dublin, Ireland, ¹²Boston Children's Hospital, Boston, MA, ¹³Emerson Hospital, Concord, MA, ¹⁴Department of Medicine, Yale University School of Medicine, New Haven, CT, ¹⁵St James hospital, Dublin, Ireland, ¹⁶Universittsklinikum Schleswig-Holstein, Kiel, Germany, ¹⁷Temple University, Philadelphia, PA, ¹⁸The Medical College of Wisconsin, Maywood, IL, ¹⁹George Washington University School of Medicine and Health Sciences, Washington, DC, ²⁰George Washington University, Melbourne, FL, ²¹Washington University School of Medicine, St. Louis, MO, ²²Newcastle University, Newcastle, United Kingdom, ²³Canadian Arthritis Patient Alliance, Ottawa, ON, Canada, ²⁴Hospital for Special Surgery, New York, NY, ²⁵University of Washington, Bellevue, WA, ²⁶Brigham and Women's Hospital, Boston, MA, ²⁷Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada, ²⁸Hospital Guillermo Almenara Irigoyen, Essalud/Universidad Científica del Sur, Lima, Peru, ²⁹New South Wales Health, Sydney, Australia, ³⁰LAC+USC/Keck Medicine of USC, Pasadena, CA, ³¹Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing 100730, China, Beijing, China (People's Republic), ³²University of Texas Southwestern Medical Center, Dallas, TX, ³³Boston University, Boston, MA, ³⁴University of Otago, Wellington, New Zealand, ³⁵Massachusetts General Hospital, Newton, MA

Meeting: ACR Convergence 2021

Keywords: COVID-19, Epidemiology

Session Information

Date: Saturday, November 6, 2021

Title: Epidemiology & Public Health Poster I: COVID-19 & Vaccination (0084–0117)

Session Type: Poster Session A

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

Background/Purpose: The relative risk of COVID-19 among patients with rheumatic and musculoskeletal disease (RMD) and the comparative severity of COVID-19 infection in RMD remain uncertain. This systematic review seeks to quantify the risk for SARS-CoV-2 infection and to describe the clinical course and outcomes of COVID-19 in people with RMD.

Methods: A systematic literature search was conducted across 14 databases from inception to February 13^th 2021. We included observational studies and experimental trials in RMD patients reporting the following outcomes: 1) comparative rates of SARS-CoV-2 infection, 2) hospitalization, 3) oxygen supplementation/ICU admission/mechanical ventilation, and 4) mortality. Studies were screened, data extracted, and quality assessment performed by two independent reviewers with a third reviewer to resolve conflicts. The methodological quality of all included studies was evaluated using the Newcastle-Ottawa scale or JBI Critical Appraisal Tools.

Results: Of 5799 abstracts screened, 528 articles underwent full text review, and 100 studies met criteria for inclusion. Most studies (54%) had low risk of bias. br>
47 studies reported comparative rates of SARS-CoV-2 infection in people with RMD, 15 showed increased rates, 28 no difference, and 4 decreased rates (Table 1). Adjusted comparative risk measures were reported in 8 studies; 4 reported increased risk, 4 showed no difference in risk.

70 studies reported hospitalization rates among RMD patients. Of the 11 studies providing comparative data (Table 2) 3 showed increased risk among patients with RMD, and 7 showed no significant effect. No studies found decreased risk for hospitalization. In 5 studies reporting adjusted analyses, 2 reported increased risk, whereas 3 found no significant differences.

In terms of oxygen supplementation (n=28 studies), 3 studies reported comparative findings: 1 showed increased risk among patients with RMD, while 2 found no significant difference. Regarding ICU admission (n=52 studies), 11 comparative studies were identified, 2 showed increased risk among RMD patients and the remainder showed no differences. For mechanical ventilation (n=42 studies), among 8 comparative studies, 7 showed no effect of RMD status and 1 showed a positive correlation. Only 2 studies reported adjusted risk estimates for ICU admission/mechanical ventilation, with 1 reporting a positive correlation, and the other, no effect.

71 studies reported mortality;16 reported comparative mortality rates (Table 3). Of these, 5 reported increased risk, 9 no difference, and 2 decreased risk in the RMD group; notably the 3 largest studies showed increased risk. 7 studies reported adjusted risk estimates. Compared to the general population, 2 studies reported increased mortality and 1 found no difference. Compared to non-RMD comparators 4 studies reported no difference in mortality.

Conclusion: This is the largest systematic review to date on COVID-19 in RMD. Although distillation of the overall results was limited by study heterogeneity, a similar number of studies reported increased risk or equal risk for RMD patients with few reporting decreased risk.

Table 1: Studies reporting comparative rates of COVID_19 infection (n=47)

Table 2: Studies reporting comparative hospitalization, oxygen supplementation, ventilation, ICU admission rates in RMD patients (n=16)

Table 3: Studies reporting comparative mortality rates in RMD patients (n=16)

Disclosures: R. Conway, Janssen, 6, Sanofi, 6, Roche, 6, Abbvie, 6; A. Grimshaw, None; M. Konig, None; M. Putman, None; A. Duarte-Garcia, None; C. Low, None; S. Jin, None; D. Cabrera, None; Y. Chock, None; B. Degirmenci, None; E. Duff, None; B. Egeli, None; E. Graef, CVS Health Corporation, 8; A. Gupta, None; P. Harkins, None; B. Hoyer, Pfizer, 1, 6, Abbvie, 6, UCB, 6; A. Jayatilleke, None; C. Kasia, None; A. Khilnani, None; A. Kilian, None; A. Kim, Kypha, Inc., 5, GlaxoSmithKline, 2, 5, 6, Alexion Pharmaceuticals, 2, Annexon Biosciences, 2, Aurinia Pharmaceuticals, 2, 6; C. Lin, None; L. Proulx, None; S. Sattui, None; N. Singh, None; J. Sparks, Bristol-Myers Squibb, 2, 5, Amgen, 5, Gilead, 2, Inova, 2, Janssen, 2, Optum, 2, Pfizer, 2; H. Tam, None; L. Tseng, None; M. Ugarte-Gil, Pfizer, 5, Janssen, 5; N. Ung, None; L. Wise, None; Z. Yang, None; K. Young, None; J. Liew, Pfizer, 5; 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; Z. Wallace, Bristol-Myers Squibb, 5, Principia/Sanofi, 5, Viela Bio, 2, MedPace, 2; E. Hsieh, None.

To cite this abstract in AMA style:

Conway R, Grimshaw A, Konig M, Putman M, Duarte-Garcia A, Low C, Jin S, Cabrera D, Chock Y, Degirmenci B, Duff E, Egeli B, Graef E, Gupta A, Harkins P, Hoyer B, Jayatilleke A, Kasia C, Khilnani A, Kilian A, Kim A, Lin C, Proulx L, Sattui S, Singh N, Sparks J, Tam H, Tseng L, Ugarte-Gil M, Ung N, Wise L, Yang Z, Young K, Liew J, Grainger R, Wallace Z, Hsieh E. SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Disease: A Systematic Literature Review [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/sars-cov-2-infection-and-covid-19-outcomes-in-rheumatic-disease-a-systematic-literature-review/. Accessed .

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