The following is a summary of the “Outcomes with and without outpatient SARS-CoV-2 treatment for patients with COVID-19 and systemic autoimmune rheumatic diseases: a retrospective cohort study,” published in the March 2023 issue of Rheumatology by Qian, et al.
Some patients with systemic autoimmune rheumatic disease and immunosuppression might still be at risk of severe COVID-19. It is unknown how SARS-CoV-2 outpatient treatments affect COVID-19 outcomes in SARD patients. Their study’s primary objective was to compare the outcomes of outpatient SARS-CoV-2 treatment for patients with systemic autoimmune rheumatic disease and COVID-19 to those of patients who did not receive outpatient treatment. In the United States, they conducted a retrospective cohort study at the Massachusetts General and Brigham Integrated Healthcare System in Boston. Their cohort consisted of adults (18+) with a history of systemic autoimmune rheumatic disease who developed COVID-19 between January 23 and May 30, 2022.
Systemic autoimmune rheumatic diseases were identified through diagnosis codes and immunomodulator prescription, and COVID-19 was identified through positive PCR or antigen test (index date defined as the date of first positive test). Medical records review confirmed SARS-CoV-2 outpatient treatments. The severity of COVID-19 was the primary outcome, and this was defined as hospitalization or death within 30 days of the index date. A rebound case of COVID-19 was defined as having evidence of a previously negative SARS-CoV-2 test following treatment, followed by a subsequent positive test. Using multivariate logistic regression, we compared the severity of COVID-19 among patients who received outpatient SARS-CoV-2 treatment versus those who did not receive outpatient treatment. They analyzed data from 704 patients who were diagnosed between January 23 and May 30, 2022 (mean age 58.5 years [standard deviation 15.9]; 536 [76%] female and 168 [24%] male; 590 [84%] White and 39 [6%] Black; 347 [49%] rheumatoid arthritis).
The incidence of SARS-CoV-2 outpatient treatments rose steadily over time (p<0.0001). A total of 426 (61%) of 704 patients received outpatient treatment (307 [44%] with nirmatrelvir–ritonavir, 105 [15%] with monoclonal antibodies, five [1%] with molnupiravir, three [<1%] with remdesivir, and six [1%] with combination treatment). There were nine (2·1%) hospitalizations or deaths among 426 patients who received outpatient treatment compared with 49 (17·6%) among 278 who did not receive outpatient treatment (odds ratio [adjusted for age, sex, race, comorbidities, and kidney function] 0·12, 95% CI 0·05–0·25). There was confirmed COVID-19 rebound in 25 (7.9%) of 318 patients who were given oral outpatient treatment. When comparing the likelihood of severe COVID-19 outcomes with and without outpatient treatment, the former was associated with lower odds. These results highlight the need for additional research on COVID-19 rebound and the importance of outpatient SARS-CoV-2 treatment for patients with systemic autoimmune rheumatic disease.
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