COVID-19 Outcomes Improved for SARD Patients Thanks to Omicron Wave

In a recent study published on medRxiv* preprint server, researchers studied the incidence and severity of coronavirus disease 2019 (COVID-19) in patients with systemic autoimmune rheumatic diseases (SARDs) in Massachusetts, USA (United States), between March 1, 2020 and January 31, 2022.

Study: Temporal trends in COVID-19 outcomes in patients with systemic autoimmune rheumatic diseases: from first wave to Omicron. Image Credit: Adao/Shutterstock

Background

Some people with SARD are at high risk of progressing to a severe form of COVID-19, leading to subsequent hospitalization and death. SARD patients suffer from underlying medical conditions including suppressed immunity and target organ damage contributing to poor immune responses to respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination natural severe treble.

Previous studies have looked at time trends in COVID-19 outcomes in SARD patients before the Omicron wave. For example, a Swedish study showed that patients with inflammatory joint disease had worse COVID-19 clinical outcomes than the general population early in the pandemic.

However, the authors hypothesized that vaccination, testing, and treatment for COVID-19 may have contributed to improved temporal outcomes of COVID-19 in people with SARDs during the last Omicron wave in the United States. United States. They therefore investigated whether clinical outcomes of COVID-19 have improved in recent periods for patients with SARDs.

About the study

In the current study, researchers calculated the weekly number of total COVID-19 cases, including severe cases, to compare by calendar period and vaccination status over five time periods ranging from the first wave of infection to the Omicron. They used logistic regression to estimate the odds ratio (OR) for severe COVID-19 for each time period compared to the previous baseline period.

The researchers also explored other notable trends among SARD patients during the ongoing pandemic. But, more importantly, they assessed whether each case of death in SARD patients was due to underlying immunosuppression or other comorbidities.

Study results

The authors identified 1449 SARD patients who suffered from COVID-19, of which 399 cases were severe. The average patient age was 58.4 years, 75.2% were female and 33.9% also had rheumatoid arthritis. Over time, the proportion of severe outcomes related to COVID-19 has decreased. The adjusted ORs of severe COVID-19 in the Omicron wave were 0.29; however, the absolute number of severe COVID-19 cases during the peak of the Omicron variant wave was similar to the peaks of other waves.

Thus, 45.6% of cases had severity between March 1 and June 30, 2020, but only 14.7% were severe between December 17, 2021 and January 31, 2022. Case severity was higher in patients with unvaccinated ARDS than in unvaccinated patients (78.4% versus 59.5%). Notably, some SARD patients were hospitalized or died during the Omicron wave. These patients tended to have other comorbidities (eg, interstitial lung disease, malignancies). These findings highlight the need for ongoing risk mitigation strategies for many patients with SARDs who may be related to SARDs or its treatment.

Regarding trends other than time, the authors noted a decrease in the proportion of SARD patients with COVID-19 who identified as black or Hispanic. The patient’s age also decreased over the study period. Several factors, including changes in access to diagnostics and treatments, and vaccination, may have contributed to these trends. The evolution of diagnostics, for example the diagnosis of infections using antigen home testing, will make the detection of mild SARS-CoV-2 infections increasingly cumbersome for epidemiological studies in patients with SARDs. More importantly, leveraging data from electronic health records will remain important to capture these trends in these patients in future studies.

conclusion

The study demonstrated a steep decline in severe COVID-19 cases among SARD patients from the start of the pandemic to recent periods, including the Omicron wave. These temporal improvements in adverse clinical outcomes of COVID-19 were likely multifactorial. Advances in COVID-19 screening, prevention, and treatment strategies have likely improved adverse clinical outcomes in patients with SARDs. Additionally, improved hospital capacity, a decrease in the number of vulnerable individuals, and a decrease in the virulence of SARS-CoV-2 variants further improved temporal outcomes in patients with SARDs.

Interestingly, although vaccination has benefited many ARDS patients with immunosuppressants, it is likely that they are still vulnerable to severe COVID-19. Future studies should extend the findings of the present study to future SARS-CoV-2 variants and consider waning immunity in patients with SARDs following vaccination or natural infection. Pre-exposure prophylaxis with tixagevimab/cilgavimab, a monoclonal antibody against SARS-CoV-2, represents an important strategy to protect high-risk patients. Therefore, future studies should also assess the actual efficacy of tixagevimab/cilgavimab in patients with ARDS.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.