Outpatient COVID therapy is associated with less severe outcomes in ARD patients!

According to the findings of a recent study published in The Lancet Rheumatology, patients with autoimmune rheumatic diseases (ARDs) who received outpatient therapy had an 88% lower risk of experiencing severe COVID-19 outcomes compared to those who did not receive such therapy.

Grace Qian and colleagues conducted a retrospective study on patients with pre-existing systemic ARDs who visited the Massachusetts General Brigham Integrated Health Care System. They compared the outcomes of individuals who received outpatient care for COVID-19 to those who did not. The study included 704 patients analyzed between January 23 and May 30, 2022. Over a calendar year, outpatient SARS-CoV-2 treatments became increasingly common (p<0.0001). Among the 704 patients, 61% received outpatient care, with 44% receiving nirmatrelvir-ritonavir, 15% receiving monoclonal antibodies, 1% receiving molnupiravir, and 1% receiving combination therapy. In contrast to the 278 individuals who did not receive outpatient care, there were only 2% hospitalizations or deaths among the 426 patients who did (odds ratio [adjusted for age, sex, race, comorbidities, and kidney function] 0.12). Among the 318 patients who received oral outpatient care, 7% experienced a confirmed COVID-19 rebound. Outpatient treatment was associated with a lower risk of severe COVID-19 outcomes than no outpatient treatment.

A 2022 study also reported the risk of severe COVID-19 outcomes in patient groups with ARDs or those who had undergone transplantation. Among 6,279 ARD patients and 222 transplant recipients who tested positive for SARS-CoV-2, the risk of hospitalization was significantly higher (adjusted odds ratio (aOR) 1.30). The highest risk factors within the ARD group were adult systemic vasculitides (aOR 2.18) and transplantation (aOR 10.56). Patients with ARDs had substantially higher odds of ICU admission (aOR 1.30), with ankylosing spondylitis and transplantation having the highest odds (aOR 2.03 and 8.13, respectively). The study also found that patients with ARDs had a higher risk of COVID-19-specific mortality (aOR 1.24), with the most substantial risk factors being ankylosing spondylitis and transplantation (aOR 2.15).

These results highlight the importance of providing outpatient SARS-CoV-2 therapy to high-risk populations, particularly those with systemic ARD and COVID-19, and the need for further COVID-19 rebound research. Although certain patient groups with ARDs or transplantation have a higher risk of severe COVID-19 outcomes, the risk varies depending on the disease. Implementing risk-reduction strategies in such populations should involve administering booster vaccinations, ensuring prompt diagnosis, and early use of available medications.

References

  1. Qian G, Wang X, Patel NJ, Kawano Y, Fu X, Cook CE, et al. Outcomes with and without outpatient SARS-CoV-2 treatment for patients with COVID-19 and systemic autoimmune rheumatic diseases: A retrospective cohort study. The Lancet Rheumatology. 2023 Mar 1;5(3):e139-50.
  2. Marozoff S, Lu N, Loree JM, Xie H, Lacaille D, Kopec JA, et al. Severe COVID-19 outcomes among patients with autoimmune rheumatic diseases or transplantation: a population-based matched cohort study. BMJ open. 2022 Aug 1;12(8):e062404.
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