Certain Factors Drive Severe COVID-19 Outcomes Among Patients With Systemic Lupus Erythematosus

Realistic coronavirus cells for research. COVID-19 concept. also known as 2019-nCov. 3D illustration.
The aim of the study was to determine the characteristics associated with severe COVID-19 outcomes among patients with systemic lupus erythematosus

Among patients with systemic lupus erythematosus (SLE), more severe COVID-19 outcomes were found to be associated with demographics factors, comorbidities, and untreated or active SLE, according to study results published in Annals of the Rheumatic Diseases.

Researchers determined factors associated with severe outcomes from COVID-19 among patients with SLE. Data regarding patients with SLE and COVID-19 were collected from the COVID-19 Global Rheumatology Alliance registry. Ordinal severity outcomes included no hospitalization, hospitalization without oxygenation, hospitalization with any ventilation or oxygenation, and death.

A multivariable logistic regression model was used to assess the association between COVID-19 severity and demographic characteristics, comorbidities, medications, and disease activity.  

In total, 1606 patients with SLE were included in the study. Characteristics associated with more severe outcomes included older age (odds ratio [OR], 1.03; 95% CI, 1.02-1.04), the male sex (OR, 1.50; 95% CI, 1.01-2.23), prednisone dose of 1 to 5 mg/day (OR, 1.86; 95% CI, 1.20-2.66), prednisone dose of 6 to 9 mg/day (OR, 2.47; 95% CI, 1.24-4.86), prednisone dose of  10 mg/day or greater (OR, 1.95; 95% CI, 1.27-2.99), no current treatment (OR, 1.80; 95% CI, 1.17-2.75), kidney disease (OR, 3.51; 95% CI, 2.42-5.09), cardiovascular disease/hypertension (OR, 1.69; 95% CI, 1.25-2.29), and moderate (OR, 1.61; 95% CI, 1.02-2.54 ) or high (OR 3.94; 95% CI, 2.11-7.34) SLE disease activity vs remission.

Age- and sex-adjusted models revealed mycophenolate, rituximab, and cyclophosphamide vs hydroxychloroquine were associated with worse outcomes. Compared with belimumab, methotrexate use had more favorable outcomes.

Study limitations included the reliance on physician reporting to the COVID-19 Global Rheumatology Alliance registry, which may be skewed to more severe cases; the inability to exclude confounders such as access to health care and socioeconomic status; and that the analysis was underpowered because data on the newly approved SLE treatments (eg, voclosporin and anifrolumab) were not available.

Researchers concluded, “Individuals with these characteristics should be prioritized for close monitoring, counselled to receive vaccination and receive preventive therapies such as monoclonal antibodies (when available) if exposed to SARS-CoV-2.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Ugarte-Gil MF, Alarcón GS, Izadi Z, et al. Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance. Ann Rheum Dis. Published online February 16, 2022. doi:10.1136/annrheumdis-2021-221636

This article originally appeared on Rheumatology Advisor