Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study

Lee, Seung Won and Shin, Youn Ho and Moon, Sung Yong and Jin, Hyun Young and Kim, So Young and Yang, Jee Myung and Cho, Seong Ho and Kim, Sungeun and Lee, Minho and Park, Youngjoo and Kim, Min Seo and Won, Hong-Hee and Hong, Sung Hwi and Kronbichler, Andreas and Koyanagi, Ai and Jacob, Louis and Smith, Lee and Lee, Keum Hwa and Suh, Dong In and Shin, Jae Il and Yon, Dong Keon (2021) Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study. The Lancet Rheumatology. ISSN 2665-9913

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Available under the following license: Creative Commons Attribution Non-commercial No Derivatives.

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Official URL: https://doi.org/10.1016/S2665-9913(21)00151-X

Abstract

Background: Real-world evidence on the association between autoimmune inflammatory rheumatic diseases, therapies related to these diseases, and COVID-19 outcomes are inconsistent. We aimed to investigate the potential association between autoimmune inflammatory rheumatic diseases and COVID-19 early in the COVID-19 pandemic. Methods: We did an exposure-driven, propensity score-matched study using a South Korean nationwide cohort linked to general health examination records. We analysed all South Korean patients aged older than 20 years who underwent SARS-CoV-2 RT-PCR testing between Jan 1 and May 30, 2020, and received general health examination results from the Korean National Health Insurance Service. We defined autoimmune inflammatory rheumatic diseases (inflammatory arthritis and connective tissue diseases) based on the relevant ICD-10 codes, with at least two claims (outpatient or inpatient) within 1 year. The outcomes were positive SARS-CoV-2 RT-PCR test, severe COVID-19 (requirement of oxygen therapy, intensive care unit admission, application of invasive ventilation, or death), and COVID-19-related death. Adjusted odds ratios (ORs) with 95% CIs were estimated after adjusting for the potential confounders. Findings: Between Jan 1 and May 30, 2020, 133 609 patients (70 050 [52·4%] female and 63 559 [47·6%] male) completed the general health examination and were tested for SARS-CoV-2; 4365 (3·3%) were positive for SARS-CoV-2, and 8297 (6·2%) were diagnosed with autoimmune inflammatory rheumatic diseases. After matching, patients with an autoimmune inflammatory rheumatic disease showed an increased likelihood of testing positive for SARS-CoV-2 (adjusted OR 1·19, 95% CI 1·03–1·40; p=0·026), severe COVID-19 outcomes (1·26, 1·02–1·59; p=0·041), and COVID-19-related death (1·69, 1·01–2·84; p=0·046). Similar results were observed in patients with connective tissue disease and inflammatory arthritis. Treatment with any dose of systemic corticosteroids or disease-modifying antirheumatic drugs (DMARDs) were not associated with COVID-19-related outcomes, but those receiving high dose (≥10 mg per day) of systemic corticosteroids had an increased likelihood of a positive SARS-CoV-2 test (adjusted OR 1·47, 95% CI 1·05–2·03; p=0·022), severe COVID-19 outcomes (1·76, 1·06–2·96; p=0·031), and COVID-19-related death (3·34, 1·23–8·90; p=0·017). Interpretation: Early in the COVID-19 pandemic, autoimmune inflammatory rheumatic diseases were associated with an increased likelihood of a positive SARS-CoV-2 PCR test, worse clinical outcomes of COVID-19, and COVID-19-related deaths in South Korea. A high dose of systemic corticosteroid, but not DMARDs, showed an adverse effect on SARS-CoV-2 infection and COVID-19-related clinical outcomes.

Item Type: Journal Article
Keywords: COVID-19, Steroid, Connective tissue disease, Inflammatory arthritis, Disease-modifying antirheumatic drugs, Autoimmune inflammatory rheumatic disease, SARS-CoV-2
Faculty: COVID-19 Research Collection
Faculty of Science & Engineering
SWORD Depositor: Symplectic User
Depositing User: Symplectic User
Date Deposited: 05 May 2021 10:04
Last Modified: 17 Sep 2021 14:50
URI: https://arro.anglia.ac.uk/id/eprint/706548

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