Huang Saisai, Ma Xiaolei, Cao Juan, Du Mengru, Zhao Zhiling, Wang Dandan, Xu Xue, Liang Jun, Sun Lingyun
Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University , 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
Department of Geriatrics, Nanjing Drum Hospital, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
J Transl Autoimmun. 2023 Dec 12;8:100227. doi: 10.1016/j.jtauto.2023.100227. eCollection 2024 Jun.
The impact of the Coronavirus disease 2019 (COVID-19) pandemic on autoimmune diseases (AID) patients has been an important focus. This study was undertaken to characterize the incidence, clinical manifestations and hospitalization among AID affected by COVID-19 and to analyze the association between immunomodulatory medication and these outcomes. Clinical, demographic, maintenance treatment, symptoms and disease course data and outcomes of AID patients with COVID-19 infection were assessed via an online survey tool and printed copy from 1 January till February 28, 2023. A total of 432 patients with AID were enrolled in the study. The results showed the most common conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was hydroxychloroquine (HCQ). The usage of csDMARDs didn't increase the risk of COVID-19 infection. Patients who warranted hospitalization were significantly older. ILD was associated with higher hospitalization rate. No csDMARDs other than calcineurin inhibitor (CNI) was associated with increased risk of hospitalization. HCQ intake was associated with cough. Compared with no glucocorticoids (GCs) group, high doses of GCs were accompanied with higher proportion of gastrointestinal symptoms and tachycardia, lower proportion of sore throat and ageusia. GCs didn't provoke the COVID-19 infection in patients with AID, but chronic use of oral GCs was significantly more common in those requiring hospitalization, and higher dose of GCs were correlated with higher risk of hospitalization. 97 patients discontinued csDMARDs after infection, which resulted in an elevated risk of hospitalization. Meanwhile, withdrawal of csDMARDs was associated with higher odds of disease flare and lower proportion of remission than maintenance groups. Collectively, our analysis provides the evidence that maintenance treatment of csDMARDs may be more prudent for AID patients during COVID-19 pandemic.
2019年冠状病毒病（COVID-19）大流行对自身免疫性疾病（AID）患者的影响一直是一个重要关注点。本研究旨在描述受COVID-19影响的AID患者的发病率、临床表现和住院情况，并分析免疫调节药物与这些结果之间的关联。通过在线调查工具和打印副本，对2023年1月1日至2月28日期间感染COVID-19的AID患者的临床、人口统计学、维持治疗、症状、病程数据及结果进行了评估。共有432例AID患者纳入本研究。结果显示，最常用的传统合成改善病情抗风湿药物（csDMARDs）是羟氯喹（HCQ）。使用csDMARDs并未增加COVID-19感染风险。需要住院治疗的患者年龄显著更大。间质性肺病（ILD）与更高的住院率相关。除钙调神经磷酸酶抑制剂（CNI）外，没有其他csDMARDs与住院风险增加相关。服用HCQ与咳嗽有关。与未使用糖皮质激素（GCs）组相比，高剂量GCs组胃肠道症状和心动过速的比例更高，咽痛和味觉丧失的比例更低。GCs不会引发AID患者的COVID-19感染，但在需要住院治疗的患者中，长期口服GCs更为常见，且更高剂量的GCs与更高的住院风险相关。97例患者在感染后停用了csDMARDs，这导致住院风险升高。同时，与维持治疗组相比，停用csDMARDs与疾病复发几率更高及缓解比例更低相关。总体而言，我们的分析提供了证据，表明在COVID-19大流行期间，对AID患者维持csDMARDs治疗可能更为谨慎。
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