No Increased Lethality in Covid-19 in Patients with Inflammatory Rheumatic Diseases Compared to the General Population - a Comparison of Two German Registries -

Background: Patients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of coronavirus disease 2019 (COVID-19). The influence of immunomodulatory drugs on the course of COVID-19 is still under debate. To investigate, whether IRD inpatients are at higher risk to develop a severe course of SARS-CoV-2 infections compared to the general population, data from the German COVID-19 registry for IRD patients and data from the Lean European Survey on SARS-CoV-2 (LEOSS) https://leoss.net/ covering inpatients from the general population with SARS-CoV-2 infections were compared.Methods: Data of inpatients from the German COVID-19 IRD registry and LEOSS from March 2020 – January 2021 were included. Data were matched for age and gender (total: 732 patients, LEOSS registry: n=366 and IRD registry: n=366). Patients with immune-mediated inflammatory diseases, cancer or immunomodulatory treatment were excluded from the LEOSS cohort. Ordinal outcome of COVID-19 severity was defined: (1) not hospitalised, (2) hospitalised/not invasively ventilated and (3) invasively ventilated/deceased. Independent associations between demographic and disease features and outcome of COVID-19 were estimated by multivariable ordinal logistic regression.Results: From March 2020 – January 2021, 4310 (LEOSS registry) and 1139 cases (IRD registry) were collected in general. From both registries, 732 matched patients were included for analyses in total. Regarding the COVID-19 associated lethality, no significant difference between both registries was observed. Oxygen administration and non-invasive ventilation were significantly more often reported in the IRD registry compared to the LEOSS registry (p 65 years, chronic obstructive pulmonary disease, diabetes mellitus, rheumatoid arthritis, spondyloarthritis and the use of rituximab were associated with more severe courses of COVID-19. Female gender and the use of tumor necrosis factor-alpha inhibitors (TNF-I) were associated with a better outcome of COVID-19.Conclusion: IRD patients have the same risk factors for severe COVID-19 regarding comorbidities compared to the general population without any immune-mediated disease or immunomodulation. Specifically, cardiovascular and chronic obstructive pulmonary diseases had an impact on the course of COVID-19. The use of rituximab was associated with an increased risk for severe COVID-19. On the other hand, the use of TNF-I was associated with less severe COVID-19 compared to the general population, which might indicate a protective effect of TNF-I in the context of COVID-19.