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POS0276 (2023)
SARS-COV-2 INFECTION OUTCOMES IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES -A DANISH NATIONWIDE COHORT STUDY
A. Svensson1, H. D. Emborg2, L. E. Bartels3, C. Ammitzbøll3, T. Ellingsen4, T. Adelsten5, R. L. Cordtz1,6, L. Dreyer6,7, N. Obel2,8,9
1Copenhagen University Hospital, Copenhagen, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
2Statens Serum Institut, Department of Infectious Disease Epidemiology and Prevention, Copenhagen, Denmark
3Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark
4Odense University Hospital, Rheumatology Research Unit, Odense, Denmark
5Zealand University Hospital, Department of Rheumatology, Køge, Denmark
6Aalborg University Hospital, Aalborg, Center of Rheumatic Research Aalborg (CERRA), Aalborg, Denmark
7Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
8Copenhagen University Hospital, Department of Infectious Diseases, Copenhagen, Denmark
9University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark

 

Background The SARS-CoV-2 pandemic initially raised concerns about the risk of severe infection in patients with inflammatory rheumatic diseases (IRD).

Objectives In a setting with an excessive SARS-CoV-2 test strategy and availability of effective vaccines we aimed to investigate if patients with (IRD) face greater risk of contracting SARS-CoV-2 infection and have an increased risk of hospitalization, assisted ventilation and death compared to the general population.

Methods This large nationwide, population-based register study compared the outcomes of SARS-CoV-2 infection in Danish patients with IRD (n=65.603) to matched population controls (n=656.030), from the first registration of SARS-CoV-2 (March 2020 to October 2022). The IRD population included 1,903 ANCA associated and necrotizing vasculitis; 30,391 rheumatoid arthritis; 2,444 Systemic lupus erythematosus; 1,538 systemic scleroderma; 2,521 sjogren’s syndrome; 5,875 giant cell arteritis and 20,931 spondylarthritis and psoriasis arthritis patients. Cox regression analyses were used to calculate incidence rate ratios (IRRs) for SARS-CoV-2 infection outcomes.

Results We observed a discrete difference in time to first and second positive SARS-COV-2 test in IRD patients compared to the general population (IRR=1.05 95% CI (1.03-1.06) and (IRR=1.17 95% 1.11-1.24). The risk of hospital contact with COVID-19 and severe COVID-19 was increased in IRD patients compared to population controls (IRR=1.92, 95% CI 1.79-2.06) and (IRR= 2.16, 95% CI 1.91-2.45). Also, the risk if hospitalization requiring assisted ventilation (IRR=2.40, 95% CI 1.93-2.99) and for hospitalization with COVID-19 leading to death were increased in the IRD population (IRR=2.02 95% CI 1.66-2.45). The risk of hospitalization with severe COVID-19 was remarkably reduced after third SARS-CoV-2 vaccination.

Conclusion IRD patients have a risk of SARS-Cov-2 which nearly corresponds to the general population but have a substantial increased risk of hospitalization with COVID-19, severe COVID-19, requiring assisted ventilation and COVID-19 leading to death compared to the general population. A third SARS-CoV-2 vaccination was associated with reduced need for hospitalization with COVID-19 and reduced the risk of death.

Table 1. Relative risk (95%CI) of first positive SARS CoV-2-test, vaccination, hospitalization and death in patients with inflammatory rheumatic diseases vs. general population controls in Denmark, March 1. 2020 to October 1. 2022.
Total ANCA associated vasculitis Rheumatoid arthritis Systemic lupuserythomatosus SystemicScleroderma Sjogren syndrome Giant cell arteritis Spondyl artritisand Psoriatic arthritis
Total number (n) 65.603 1.903 30.391 2.444 1.538 2.521 5.875 20.931
Outcome IRR(95%CI)
Time to first positive SARS-CoV-2 test 1.05(1.03-1.06) 1.10(1.02-1.19) 1.04(1.02-1.06) 0.90(0.85-0.96) 0.96(0.88-1.05) 0.96(0.89-1.02) 1.12(1.06-1.18) 1.12(1.06-1.18)
Time to second positive SARS-CoV-2 test 1.17(1.11-1.24) 1.92(1.40-2.64) 1.21(1.10-1.33) 0.89(0.68-1.17) 0.87(0.57-1.33) 0.94(0.69-1.29) 1.36(1.00-1.84) 1.14(1.04-1.24)
Time to first positive hospital contact with covid-19 1.92(1.79-2.06) 6.19(4.41-8.69) 1.91(1.71-2.13) 3.01(2.04-4.43) 3.04(1.90-4.86) 2.51(1.63-3.86) 3.01(2.04-4.43) 3.01(2.04-4.43)
Time to hospitalization with severe covid-19 2.16(1.91-2.45) 8.22(4.77-14.16) 2.00(1.66-2.42) 3.62(1.61-8.16) 3.66(1.62-8.23) 2.10(0.92-4.80) 1.60(1.04-2.48) 1.55(1.16-2.07)
Time to hospitalization with assisted ventilation 2.40(1.93-2.99) 8.98(3.97-20.33) 1.99(1.42-2.79) 5.05(1.02-25.04) 6.13(1.87-20.07) 0.83(0.10-6.91) 2.14(0.98-4.67) 2.14(0.98-4.67)
Time to hospitalization with covid-19 followed by death 2.02(1.66-2.45) 6.31(2.49-15.99) 2.47(1.89-3.23) 3.78(0.85-16.90) 1.90(0.50-7.17) 2.49(0.46-13.61) 1.13(0.63-2.01) 1.00(0.54-1.85)
Time to Severe covid-19 after 3. vaccination 0.42(0.25-0.72) 1.02(0.25-4.18) 0.38(0.17-0.86) 0.08(0.01-0.50) NA NA 0.19(0.03-1.10) 0.35(0.07-1.09)

REFERENCES:

    NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

Keywords: COVID, Prognostic factors, Vaccination/Immunization

DOI: 10.1136/annrheumdis-2023-eular.1116

Citation: , volume 82, supplement 1, year 2023, page 378
Session: All about COVID-19 in Rheumatology (Poster Tours)