Potential for Severe COVID-19 Outcomes Among Patients With Vasculitis

A recent study found that several variable and largely unmodifiable risk factors for patients with primary systemic vasculitis and polymyalgia rheumatica were associated with severe COVID-19 outcomes. These risk factors include age, sex, number of comorbidities, and treatments such as high-dose glucocorticoids.

Using the COVID-19 Global Rheumatology Alliance Registry, researchers identified adult patients diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behçet syndrome, or other vasculitis) or polymyalgia rheumatica and investigated factors associated with COVID-19 outcomes. The COVID-19 outcomes of these patients were assessed using an ordinal COVID-19 severity scale: (1) no hospitalization, (2) hospitalization without supplemental oxygen, (3) hospitalization with supplemental oxygen or ventilation, or (4) death. Analyses were adjusted for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category, and were stratified by type of rheumatic disease.

Of the 1202 eligible patients that were identified in the registry (733 or 61.0% women, 469 or 39.0% men, with a mean age of 63.8 years), there were 372 (31.3%) patients with polymyalgia rheumatica, 353 (29.4%) with ANCA-associated vasculitis, 183 (15.2%) with giant cell arteritis, 112 (9.3%) with Behçet syndrome, and 180 (15.0%) with other vasculitis. There were 1020 (84.9%) patients with outcome data: 512 (50.2%) were not hospitalized, 114 (11.2%) were hospitalized and did not receive supplemental oxygen, 239 (23.4%) were hospitalized and received ventilation or supplemental oxygen, and 155 (15.2%) died.

Researchers observed a higher odds of poor COVID-19 outcomes “in patients who were older (per each additional decade of life OR 1.44 [95% CI 1.31–1.57]), were male compared with female (1.38 [1.05–1.80]), had more comorbidities (per each additional comorbidity 1.39 [1.23–1.58]), were taking 10 mg/day or more of prednisolone compared with none (2.14 [1.50–3.04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2.12 [1.49–3.02]).” These risk factors varied among different subtypes.

The researchers state that the results of this study can be used to inform mitigation strategies for patients who have these diseases.

—Allison Casey

Conway R, Putman MS, Sattui SE, et al. Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study. Lancet Rheumatol. 2021;3(12):855-864.