close
close

COVID-19 outcomes improved for SARDs patients by the Omicron wave

In a recently published study medRxiv* Pre-print server, Researchers surveyed the incidence and severity of coronavirus disease 2019 (COVID-19) in patients with systemic autoimmune rheumatic diseases (SARDs) in Massachusetts, USA between March 1, 2020 and January 31, 2022 ( UNITED STATES).

Study: Temporal Trends in COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases: From the First Wave to Omicron.  Image credit: Adao/ShutterstockStudy: Temporal Trends in COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases: From the First Wave to Omicron. Image credit: Adao/Shutterstock

background

Some people with SARDs are at high risk of progressing to severe COVID-19, leading to subsequent hospitalization and death. SARD patients have underlying medical conditions, including suppressed immunity and end-organ damage, that contribute to a poor immune response to natural severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination.

Previous studies examined temporal trends in COVID-19 outcomes in SARD patients prior to the Omicron wave. For example, a Swedish study showed that patients with inflammatory joint disease had poorer clinical outcomes from COVID-19 than the general population at the onset of the pandemic.

However, the authors hypothesized that COVID-19 vaccination, testing, and treatment during the recent Omicron surge in the US may have contributed to improved temporal COVID-19 outcomes in people with SARDs. Therefore, they examined whether clinical COVID-19 outcomes have improved in recent periods for patients with SARDs.

About the study

In the present study, the researchers calculated the weekly number of total COVID-19 cases, including severe cases, to compare them by calendar period and vaccination status over five time periods from the first wave of infection to the Omicron wave. They used logistic regression to estimate the odds ratios (ORs) for severe COVID-19 for each period compared to the previous reference period.

The researchers also examined other notable trends in patients with SARDs during the ongoing pandemic. But, more importantly, they assessed whether each death in SARD patients was due to underlying immunosuppression or other comorbidities.

study results

The authors identified 1449 SARD patients suffering from COVID-19, 399 of whom were severe cases. The mean age of the patients was 58.4 years, 75.2% were female and 33.9% also had rheumatoid arthritis. Over time, the proportion of severe COVID-19 outcomes decreased. The adjusted ORs of severe COVID-19 in the Omicron wave were 0.29; However, the absolute number of severe COVID-19 cases during the peak of the Omicron variant wave was similar to the peaks of other waves.

Accordingly, 45.6% of cases showed severity between March 1st and June 30th, 2020, but only 14.7% were serious between December 17th, 2021 and January 31st, 2022% versus 59.5%). Notably, some patients with SARDs were hospitalized or died during the Omicron wave. These patients tended to have other comorbidities (eg, interstitial lung disease, malignancies). These results underscore the need for ongoing risk reduction strategies for many SARD patients that may be related to SARD or its treatment.

In terms of trends other than time, the authors noted a decrease in the proportion of SARDs patients with COVID-19 who identified as Black or Hispanic. The age of the patient also decreased during the study period. Several factors may have contributed to these trends, including changes in access to diagnostics and treatments, and vaccinations. The shift in diagnostics, e.g. B. Diagnosing infections with rapid antigen tests at home will make it increasingly difficult to detect mild SARS-CoV-2 infections for epidemiological studies in SARD patients. More importantly, the use of electronic medical record data will remain important to capture such trends in these patients in future studies.

Conclusions

The study showed a sharp decline in severe COVID-19 cases in SARD patients from the beginning of the pandemic to recent periods, including the Omicron wave. These temporal improvements in COVID-19 adverse clinical outcomes were likely multifactorial. Advances in COVID-19 testing, prevention and treatment strategies likely improved negative clinical outcomes in SARD patients. In addition, improved hospital capacity, a reduction in the number of people at risk, and reduced virulence of SARS-CoV-2 variants further improved temporal outcomes in SARD patients.

Interestingly, although vaccination has benefited many SARD patients on immunosuppressants, it is likely that they are still susceptible to severe COVID-19. Future studies should extend the observations of the present study to future SARS-CoV-2 variants and consider the decreasing immunity in SARD patients after vaccination or natural infection. Pre-exposure prophylaxis with tixagevimab/cilgavimab, a monoclonal antibody against SARS-CoV-2, represents an important strategy to protect high-risk patients. Therefore, future studies should also evaluate the practical efficacy of tixagevimab/cilgavimab in patients with SARD.

*Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be relied upon as conclusive, guide clinical practice/health behavior, or be treated as established information.

Magazine reference:

  • Temporal Trends in COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases: From the First Wave to Omicron, Yumeko Kawano, Naomi J Patel, Xiaosong Wang, Claire E Cook, Kathleen MM Vanni, Emily N Kowalski, Emily P .Banasiak, Grace Qian, Michael DiIorio, Tiffany Y.-T. Hsu, Michael E Weinblatt, Derrick J Todd, Zachary S Wallace, Jeffrey A Sparks, medRxiv pre-print 2022, DOI: https://doi.org/10.1101/2022.06.19.22276599, https://www.medrxiv.org/content/10.1101/2022.06.19.22276599v1

Leave a Comment