Outpatient Care Decreases Risk for Severe COVID-19 Outcomes in Rheumatic Disease

Outpatient care decreases risk for severe COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases, according to study results published in Lancet Rheumatology.

Patients with established systemic autoimmune rheumatic disease who tested positive for SARS-CoV-2 between January and May 2022 at 1 of the 14 hospitals or outpatient care centers affiliated with Mass General Brigham Integrated Health Care System in Boston were included in the study.

The primary outcome was severe COVID-19, defined as COVID-19-related hospitalization or death within 30 days of a positive SARS-CoV-2 test.

The study population (N=704) included individuals aged a mean of 58.4 (SD, 15.9) years; 76% were women; 84% were White; and 96% had received a COVID-19 vaccine. The most common rheumatic diseases were rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus.

Overall, 61% of patients received outpatient care for COVID-19. Researchers observed that a higher percentage of women, White individuals, those without severe kidney impairments, and vaccinated individuals received outpatient care.

The most common outpatient treatment was nirmatrelvir-ritonavir (44%), followed by monoclonal antibodies (15%).

The rate of COVID-19 hospitalizations was 8.2%, and the mortality rate was 0.4%. Stratified by outpatient care, hospitalizations and mortality rates were lower among those who received outpatient care compared with those who did not (2.1% vs 17.6% and 0.2% vs 0.7%, respectively). Among patients who received outpatient care, those who received nirmatrelvir-ritonavir had lower rates of hospitalizations than those who received monoclonal antibodies (1.3% vs 4.8%).

In the fully adjusted model, any vs no outpatient care was associated with decreased risk for severe COVID-19 (adjusted odds ratio [aOR], 0.13; 95% CI, 0.06-0.28).

In the secondary analyses, lower risk for severe COVID-19 was observed for nirmatrelvir-ritonavir (aOR, 0.09; 95% CI, 0.03-0.27) and monoclonal antibody (aOR, 0.21; 95% CI, 0.08-0.57) treatments compared with no outpatient care and nirmatrelvir-ritonavir (aOR, 0.13; 95% CI, 0.04-0.37) or monoclonal antibody (aOR, 0.35; 95% CI, 0.13-0.99) treatments compared with no outpatient care plus all other treatments.

However, study results were not representative of the entire population of patients with systemic rheumatic disease who tested positive for COVID-19.

The study authors concluded, “These findings highlight the importance of outpatient SARS-CoV-2 treatment for patients with systemic autoimmune rheumatic disease and COVID-19 and the need for further research on COVID-19 rebound.”

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.