Moderate, high dose steroids linked to more severe COVID-19
Preliminary data from the COVID-19 Global Rheumatology Alliance Provider Registry suggested that moderate- to high-dose steroid use is associated with a more severe COVID-19 disease course, with older age and comorbidities linked to an increased risk for hospitalization, according to a presenter...
Moderate, high dose steroids linked to more severe COVID-19
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Jinoos Yazdany
Preliminary data from the COVID-19 Global Rheumatology Alliance Provider Registry suggested that moderate- to high-dose steroid use is associated with a more severe COVID-19 disease course, with older age and comorbidities linked to an increased risk for hospitalization, according to a presenter at the virtual ACR State-of-the-Art Clinical Symposium.
“Remarkably, this entire effort started with a tweet — on March 11, Len Calabrese [DO, RJ Fasenmyer chair of clinical immunology at the Cleveland Clinic] recommended that rheumatology follow the lead of our inflammatory bowel disease colleagues who had started a similar registry just days before,” Jinoos Yazdany, MD, MPH, University of California, San Francisco, told attendees. “Over a period of a couple weeks, people around the world volunteered and got together a registry that we launched on March 24 — case counts have been rising steadily over the last few weeks thanks to everybody’s participation.”
The registry currently houses data on more than 1,400 cases reported by 288 organizations and more than 300 investigators, Yazdany said. Its two main objectives are to analyze the outcomes of patient s with rheumatic disease and COVID-19, and determine whether any inferences can be made regarding immunosuppressive and anti-malarial drugs.
The registry includes patients with inflammatory rheumatic disease who had been sick enough to receive a COVID-19 test and diagnosis. Considering that only some practices have systems for capturing all patients with COVID-19, Yazdany said that most of the cases included in the Global Rheumatology Alliance registry are “on the sicker end of the spectrum.”
Preliminary data from the COVID-19 Global Rheumatology Alliance Provider Registry suggested that moderate- to high-dose steroid use is associated with a more severe COVID-19 disease course, with older age and comorbidities linked to an increased risk for hospitalization, according to Yazdany.
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That said, a soon-to-be-published analysis of 600 registry cases from 40 countries — mostly from North America and Europe — suggests that prednisone doses of more than 10 mg per day is associated with a higher risk for hospitalization, according to Yazdany. This effect remained even after adjusting for disease activity, she added. Older age and comorbidities also increased the risk for hospitalization.
In contrast, the researchers found fewer hospitalizations among patients treated with biologic or targeted synthetic DMARDs only. They did not find a significant association between antimalarials, such as hydroxychloroquine, either as monotherapy or in combination with another drug, and hospitalization. Further, patients treated with TNF inhibitors experienced fewer hospitalization in adjusted models.
“When we looked more carefully at the biologic, or targeted synthetic DMARD category, we were really only powered to look, drug-by-drug at TNF users, which was more than half of the people in that category,” Yazdany said. “We are not yet powered to look at other drug categories, but hopefully as the registry grows, we will be able to do this type of analysis for other specific drugs.”
Still, despite limitations in the data, which include the potential for residual confounding and selection bias, the registry’s timeliness has allowed the rheumatology community to “rapidly dispel” misinformation regarding the preventive benefits of hydroxychloroquine, according to Yazdany.
“Especially things like the notion that patients with lupus are not getting COVID-19,” she said. “We know from these data that is not true.”
It has also given rheumatologists the information necessary to reassure patients that most people with rheumatic diseases who catch COVID-19 are recovering, even in this more severe cohort of patients, she added.
“Larger sample sizes will allow us to study specific disease, drug and comorbidity risk factors,” Yazdany said. “I encourage everyone to continue to enter cases so that our community can learn from every patient, and get data out there quickly, during the pandemic.” – by Jason Laday
Reference:
Yazdany, J. COVID-19 epidemiology, transmission and insights from global registry data. Presented at: American College of Rheumatology State-of-the-Art Clinical Symposium. May 16-17, 2020 (virtual meeting).
Disclosures: Yazdany reports research support from NIH/NIAMS, CDC and the Agency for Healthcare Research and Quality, as well as consulting fees from Astra Zeneca and Eli Lilly.