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Deutscher Rheumatologiekongress 2021, 49. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 35. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), Wissenschaftliche Herbsttagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)

15.09. - 18.09.2021, virtuell

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Immunosuppressive profile of deadly courses of COVID-19 in a large-scale real-life rheumatic cohort

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  • Rebecca Hasseli - Campus Kerckhoff, Justus-Liebig-University Gießen, Department of Rheumatology and Clinical Immunology, Gießen
  • Bimba F. Hoyer - University Hospital Schleswig-Holstein, Campus Kiel, Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, Kiel
  • Andreas Krause - Immanuel Hospital, Department of Rheumatology, Clinical Immunology and Osteology, Berlin
  • Hanns-Martin Lorenz - University Hospital Heidelberg, Division of Rheumatology, Department of Medicine V, Heidelberg
  • Alexander Pfeil - University Hospital Jena, Department of Internal Medicine III, Jena
  • Anne Regierer - German Rheumatism Research Centre, Epidemiology Unit, Berlin
  • Jutta Richter - Heinrich-Heine-University Düsseldorf, Department of Rheumatology and Hiller Research Unit, Düsseldorf
  • Tim Schmeiser - Private Practice, Cologne
  • Anja Strangfeld - German Rheumatism Research Centre, Epidemiology Unit, Berlin
  • Reinhard Voll - University of Freiburg, Faculty of Medicine, Department of Rheumatology and Clinical Immunology, Freiburg
  • Ulf Müller-Ladner - Campus Kerckhoff, Justus-Liebig-University Gießen, Department of Rheumatology and Clinical Immunology, Gießen
  • Hendrik Schulze-Koops - University of Munich, Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Munich
  • Christof Specker - Kliniken Essen-Mitte, Essen, Department of Rheumatology and Clinical Immunology, Essen

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. Deutscher Rheumatologiekongress 2021, 49. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 35. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), Wissenschaftliche Herbsttagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). sine loco [digital], 15.-18.09.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocCO.09

doi: 10.3205/21dgrh009, urn:nbn:de:0183-21dgrh0096

Veröffentlicht: 14. September 2021

© 2021 Hasseli et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Introduction: Patients with inflammatory rheumatic diseases (IRD) are routinely treated with disease-modifying anti-rheumatic drugs (DMARDs). After more than a year of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, still few data are available on the association of DMARDs with fatal courses of SARS-CoV-2 infection (COVID-19) in IRD patients. On the other hand, DMARDs offer an anti-inflammatory treatment option in severe COVID-19 [1]. Therefore, the aim of this study was to analyse the profile of deceased IRD patients with COVID-19 regarding their DMARDs on a large-scale basis.

Methods: We analysed fatal courses of the German COVID-19 IRD-registry (until April 5th 2021, 2253 cases, 1515 women) [2]. In Germany, no prescription bias exists, as all DMARDs can be prescribed in label based on the discretion of the treating rheumatologist.

Results: In 4 % of the cases (n = 88, 46 women, median age 75 years), COVID-19 related death was reported. The main IRD diagnosis among deceased patients was rheumatoid arthritis (59 %) followed by granulomatosis with polyangiitis (16 % versus 2% in total). As major complications were reported acute respiratory distress syndrome (50 %), sepsis (28 %) and concomitant infection (26 %). In 98% of the cases, an inpatient death was reported and 73% needed invasive ventilation.

Most of the patients received glucocorticoids (GC, 67 %), 31% methotrexate and 18% rituximab. In 13 % of the cases, treatment with Janus kinase inhibitors (JAK-I) was reported. Of note, 3 out of a total of 27 patients in the registry on interleukin-1 blockade (IL-1-I) had a fatal outcome, but only one out of 483 patients treated with tumor necrosis factor inhibitors (TNF-I, Table 1 [Tab. 1]).

Conclusion: Our data argue that treatment with GC, rituximab, IL-1-I and JAK-I might be associated with an increased mortality in IRD. However, even though confounding by other disease specific issues cannot be excluded, the marked differences regarding rituximab (18% mortality), IL-1-I (14% mortality) and JAK-I (13% mortality) as an unfavourable risk factor and TNF-I as potentially protective is striking and deserves further analyses.

Disclosures: None declared

Gliederung

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