Manuel Francisco Ugarte-Gil, Graciela S Alarcón, Zara Izadi, Ali Duarte-García, Cristina Reátegui-Sokolova, Ann Elaine Clarke, Leanna Wise, Guillermo J Pons-Estel, Maria Jose Santos, Sasha Bernatsky, Sandra Lúcia Euzébio Ribeiro, Samar Al Emadi, Jeffrey A Sparks, Tiffany Y -T Hsu, Naomi J Patel, Emily L Gilbert, Maria O Valenzuela-Almada, Andreas Jönsen, Gianpiero Landolfi, Micaela Fredi, Tiphaine Goulenok, Mathilde Devaux, Xavier Mariette, Viviane Queyrel, Vasco C Romão, Graca Sequeira, Rebecca Hasseli, Bimba Hoyer, Reinhard E Voll, Christof Specker, Roberto Baez, Vanessa Castro-Coello, Hernan Maldonado Ficco, Edgard Torres Reis Neto, Gilda Aparecida Aparecida Ferreira, Odirlei Andre André Monticielo, Emily Sirotich, Jean Liew, Jonathan Hausmann, Paul Sufka, Rebecca Grainger, Suleman Bhana, Wendy Costello, Zachary S Wallace, Lindsay Jacobsohn, Tiffany Taylor, Clairissa Ja, Anja Strangfeld, Elsa F Mateus, Kimme L Hyrich, Loreto Carmona, Saskia Lawson-Tovey, Lianne Kearsley-Fleet, Martin Schäfer, Pedro M Machado, Philip C Robinson, Milena Gianfrancesco, and Jinoos Yazdany
AimTo determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19.MethodsPeople with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity.ResultsA total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1–5 mg/day 1.86, 1.20 to 2.66, 6–9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab.ConclusionsMore severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.