CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory rheumatism or autoimmune diseases

Kevin Chevalier; Michaël Genin; Thomas Petit Jean; Jerôme Avouac; Rene-Marc Flipo; Sophie Georgin-Lavialle; Soumaya El Mahou; Edouard Pertuiset; Thao Pham; Amelie Servettaz; Hubert Marotte; Fanny Domont; Pascal Chazerain; Mathilde Devaux; Arsene Mekinian; Jérémie Sellam; Bruno Fautrel; Diane Rouzaud; Esther Ebstein; Nathalie Costedoat-Chalumeau; Christophe Richez; Eric Hachulla; Xavier Mariette; Raphaèle Seror

doi:10.3389/fmed.2023.1152587

CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory rheumatism or autoimmune diseases

Front Med (Lausanne). 2023 Mar 22:10:1152587. doi: 10.3389/fmed.2023.1152587. eCollection 2023.

Authors

Kevin Chevalier¹, Michaël Genin², Thomas Petit Jean³, Jerôme Avouac⁴, Rene-Marc Flipo⁵, Sophie Georgin-Lavialle⁶, Soumaya El Mahou⁷, Edouard Pertuiset⁸, Thao Pham⁹, Amelie Servettaz¹⁰, Hubert Marotte¹¹, Fanny Domont¹², Pascal Chazerain¹³, Mathilde Devaux¹⁴, Arsene Mekinian¹⁵, Jérémie Sellam¹⁶, Bruno Fautrel¹⁷, Diane Rouzaud¹⁸, Esther Ebstein¹⁹, Nathalie Costedoat-Chalumeau²⁰, Christophe Richez²¹, Eric Hachulla²², Xavier Mariette¹, Raphaèle Seror¹

Affiliations

¹ Department of Rheumatology, Université Paris-Saclay, INSERM UMR 1184: Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
² University of Lille, CHU Lille, ULR 2694-METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France.
³ AP-HP, Département Innovation et Données, Paris, France.
⁴ Cochin Hospital, Rheumatology A, Paris, France.
⁵ Université de Lille, Rheumatology, Lille, France.
⁶ Tenon Hospital, Internal Medicine, Paris, France.
⁷ Hospital Center De Tourcoing, Rheumatology, Tourcoing, France.
⁸ Hospital Rene Dubos, Rheumatology, Pontoise, France.
⁹ Hospital Sainte Marguerite, Rheumatology, Marseille, France.
¹⁰ Hospital Robert Debré, Internal Medicine, Infectious Diseases and Clinical Immunology, Reims, France.
¹¹ University Hospital of Saint-Étienne, Rheumatology, Saint-Priest-en-Jarez, France.
¹² University Hospitals Pitié Salpêtrière - Charles Foix, Internal Medicine and Clinical Immunology, Paris, France.
¹³ Hopital de la Croix Saint-Simon, Rheumatology and Internal Medicine, Paris, France.
¹⁴ Saint-Germain-en-Laye Intercommunal Hospital Center, Internal Medicine, Poissy, France.
¹⁵ Hospital Saint-Antoine AP-HP, Internal Medicine, Paris, France.
¹⁶ Hospital Saint-Antoine AP-HP, Rheumatology, Paris, France.
¹⁷ Sorbonne Universite - APHP, Pitie Salpetriere Hospital, Department of Rheumatology, Pierre Louis Institute of Epidemiology and Public Health, INSERM UMRS 1136, Paris, France.
¹⁸ Bichat-Claude Bernard Hospital, Internal Medicine, Paris, France.
¹⁹ Bichat-Claude Bernard Hospital, Rheumatology, Paris, France.
²⁰ Cochin Hospital, Internal Medicine, Paris, France.
²¹ Chu Bordeaux - Site Pellegrin, Rheumatology, Bordeaux, France.
²² Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for Rare Systemic Autoimmune Diseases North and North-West of France (CeRAINO), CHU Lille, University of Lille, INSERM, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France.

Abstract

Introduction: Autoimmune/inflammatory rheumatic diseases (AIRDs) patients might be at-risk of severe COVID-19. However, whether this is linked to the disease or to its treatment is difficult to determine. This study aimed to identify factors associated with occurrence of severe COVID-19 in AIRD patients and to evaluate whether having an AIRD was associated with increased risk of severe COVID-19 or death.

Materials and methods: Two databases were analyzed: the EDS (Entrepôt des Données de Santé, Clinical Data Warehouse), including all patients followed in Paris university hospitals and the French multi-center COVID-19 cohort [French rheumatic and musculoskeletal diseases (RMD)]. First, in a combined analysis we compared patients with severe and non-severe COVID-19 to identify factors associated with severity. Then, we performed a propensity matched score case-control study within the EDS database to compare AIRD cases and non-AIRD controls.

Results: Among 1,213 patients, 195 (16.1%) experienced severe COVID-19. In multivariate analysis, older age, interstitial lung disease (ILD), arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory diseases, and treatment with corticosteroids or rituximab were associated with increased risk of severe COVID-19. Among 35,741 COVID-19 patients in EDS, 316 having AIRDs were compared to 1,264 Propensity score-matched controls. AIRD patients had a higher risk of severe COVID-19 [aOR = 1.43 (1.08-1.87), p = 0.01] but analysis restricted to rheumatoid arthritis and spondyloarthritis found no increased risk of severe COVID-19 [aOR = 1.11 (0.68-1.81)].

Conclusion: In this multicenter study, we confirmed that AIRD patients treated with rituximab or corticosteroids and/or having vasculitis, auto-inflammatory disease, and sarcoidosis had increased risk of severe COVID-19. Also, AIRD patients had, overall, an increased risk of severe COVID-19 compares general population.

Keywords: COVID-19; auto-immune diseases; inflammatory rheumatic diseases; lupus; rheumatic and musculoskeletal diseases; rituximab; vasculitis.

Copyright © 2023 Chevalier, Genin, Jean, Avouac, Flipo, Georgin-Lavialle, El Mahou, Pertuiset, Pham, Servettaz, Marotte, Domont, Chazerain, Devaux, Mekinian, Sellam, Fautrel, Rouzaud, Ebstein, Costedoat-Chalumeau, Richez, Hachulla, Mariette and Seror.