Until now, information about the factors associated with severe COVID outcomes in people with psoriasis, PsA, or axSpA have been lacking – including how specific treatments for these conditions might impact outcomes. Professor Pedro Machado presented new data from the COVID-19 PsoProtect and Global Rheumatology Alliance physician-reported registries, confirming that more severe COVID-19 outcomes in this group are largely driven by demographic factors (age, sex), comorbidities, and active disease – as has been seen for other RMDs.
This pooled analysis of data from the two registries included over 5,000 patients. Overall, 14.6% of cases were hospitalised (but survived), and 1.8% died. Modelling revealed that being older and male was associated with more severe outcomes from the infection. People also tended to do worse if they had other underlying diseases, such as hypertension, lung disease, chronic kidney disease, diabetes, or if they were obese. Some elements of the RMD also played a role. For example, people with higher disease activity and those using glucocorticoid medicines also tended to have more severe COVID-19 outcomes. Conversely, there were some variables that were associated with less severe COVID-19 outcomes. This included contracting the infection later in the pandemic compared to those who had COVID before June 2020. Importantly, none of the disease-modifying anti-rheumatic drugs (DMARDs) typically used in people with psoriasis, PsA, or axSpA, were associated with severe COVID-19 outcomes; this included IL-17i, IL-23/IL12+23i, JAKi, and apremilast.
Dr Su-Ann Yeoh and colleagues also examined the COVID-19 Global Rheumatology Alliance physician-reported registry to report on the factors associated with severe COVID-19 outcomes in 348 people with IIM. These are the first global registry data on the impact of COVID-19 in this patient population. As withother RMDs, people who were older, male, and had higher comorbidity burden or disease activity had worse outcomes from COVID-19 infection. Again, higher glucocorticoid intake and rituximab exposure were also risk factors for a more severe COVID-19 infection. These findings will inform risk stratification and management decisions for people with IIM.
Another area where information has been scarce until now is around vaccination safety in children and young people with RMDs, and current vaccination guidance is based on data from adults with RMDs or young people without RMDs. Ms Saskia Lawson-Tovey presented findings from 36 adolescents with inflammatory RMDs and 74 adults with juvenile idiopathic arthritis (JIA).
Overall, 56% of adolescents and 62% of adults experienced early reactogenic-like side effects within 7 days of vaccination. No adolescents reported SARS-CoV-2 infection post-vaccination, although three women were diagnosed post-vaccination in the adult group, all of whom fully recovered. The authors conclude that COVID-19 vaccines appear safe in adolescents with RMDs and adults with JIA, with a low frequency of disease flares, serious adverse events, and COVID infection seen in both populations. It should be noted that this dataset is limited by its size and does not follow patient outcomes over time, therefore further research is needed in this area.