Among patients with systemic lupus erythematosus (SLE) who received treatment at a single Italian center, the incidence of SARS-CoV-2 infection during a 6-month period was found to be 1.8%, with all patients developing mild disease and not being admitted to the intensive care unit (ICU), according to study results published in PLoS One.

The objective of the study was to determine the incidence and course of COVID-19 in patients with SLE, to explore the correlations with disease characteristics and therapy, and to evaluate the effect of treatment discontinuation on disease activity.

The study cohort included 332 patients (median age, 47 years; 303 women) with SLE who received treatment at the Rheumatology Unit of the University of Pisa in Italy. All patients were interviewed during the first wave of the pandemic, between February and July 2020, and were considered to be positive for SARS-CoV-2 infection in the presence of a positive nasopharyngeal swab or positive serology with suggestive symptoms of the viral infection.


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Of the 332 patients, 6 (1.8%) tested positive for SARS-CoV-2 infection, of whom 3 required hospitalization; however, the disease course was mild in all patients and none of them were admitted to the ICU. One patient was found to be asymptomatic and admitted to the hospital for a non-COVID-19-related cause.

Although there was no significant difference in the use of conventional synthetic disease modifying antirheumatic drugs (DMARDs) among patients with and without COVID-19 (16.7% vs 35.9%, respectively; P =.33), treatment with biologic DMARDs was more common among those with COVID-19 (50% vs 11.7%, P =.005).

Of all study participants, 36 (11.0%) discontinued 1 or more drugs for SLE as a result of their physician’s advice or personal choice. Disease flares were recorded in 27 (8.1%) cases during the study period and there was a statistically significant correlation between SLE flare and discontinuation of therapy (P <.001). Study authors did not note significant differences in incidence of SLE flares in 147 study participants between 2019 and 2020 (11.6% vs 8.8%, respectively).

The study had several limitations, including the relatively small sample size and the potential for underestimating asymptomatic patients, and that not all patients were screened for SARS-CoV-2 infection.

“[O]ur findings suggest that immunosuppressive treatment should not be preventatively discontinued in patients [with] SLE, but they should be adequately monitored because the infection can mimic disease activity,” the study authors concluded.

Reference

Zucchi D, Tani C, Elefante E, et al. Impact of first wave of SARS-CoV-2 infection in patients with systemic lupus erythematosus: weighting the risk of infection and flare. PLoS One. Published online January 13, 2021. doi:10.1371/journal.pone.0245274