Desfechos clínicos da COVID-19 em pacientes com Lúpus Eritematoso Sistêmico: dados do Registro ReumaCoV-Brasil

Abstract

Background: Systemic Lupus Erythematosus (SLE) is a chronic connective tissue disease with high morbidity and mortality due to infection. Since the beginning of the novel coronavirus (COVID-19) pandemic, the impact of this emerging infection on SLE patients has been a cause for concern. Objectives: To assess the impact of COVID-19 on SLE patiens. Methods: a multicenter, observational, and prospective cohort study. SLE adult patients with COVID-19 (case group) were compared to SLE patients without COVID-19 (control group). Assessments were performed at baseline (V0), immediately after COVID-19 (V1), and three and six months after infection (V2 and V3). Disease activity was evaluated by patient global assessment (PGA) and the modified SLE Disease Activity Index 2000 (SLEDAI-2K). A flare was defined as increase in SLEDAI-2K score greater than three and persistent disease activity was measured by SLEDAI-2K greater than three over two consecutive visits. Results: 715 SLE patients were included, 363 (50.7%) with COVID-19 and 352 (49.3%) in the control group. The COVID-19 group had higher mean age 41 years (12.38) versus 38.8 years (12.07) in the control (p=0.017). There was no difference between groups at baseline regarding comorbidities, treatment or disease activity indices. Arterial hypertension (OR 2.48 [CI 95% 1.04–5.91], p = 0.041), cyclophosphamide (OR 14.32 [CI 95% 2.12–96.77], p = 0.006), dyspnea (OR: 7.10 [CI 95% 3.10–16.23], p < 0.001) and discontinuation of SLE treatment medication during infection (5.38 [CI 95% 1.97–15.48], p = 0.002), were independently associated with a higher chance of hospitalization related to COVID-19. Patients who received telemedicine support presented a 67% lower chance of hospitalization (OR 0.33 [CI 95% 0.12–0.88], p = 0.02). The control group showed a significant reduction in PGA [0.24 (95% CI: -0.39 to -0.09), p=0.001] and SLEDAI-2K [0.85 (95% CI: 0.76 to 0.96) p=0.010] throughout the visits (Generalized Estimating Equations regression model) while in the case group the scores remained stable. Case group presented more frequent flares or persistent disease activicty [74 (18.5%) versus 33 (10.5%), p=0.001]. COVID-19 at any time in the study was linked to a higher chance of a flare or persistent disease activict [OR=1.70 (95% CI: 1.06 to 2.74), p=0.029]. Conclusion: Hypertension and cyclophosphamide were associated with a severe outcome, and telemedicine can be a useful tool for SLE patients with COVID-19. COVID-19 were associated with flare in this sample of SLE patients