Outpatient COVID-19 Treatment in Patients with Rheumatic Diseases Is Associated with Reduced Hospitalization and Mortality

By Rebecca Araujo - Last Updated: February 1, 2023

A study in The Lancet Rheumatology sought to understand the experiences and outcomes of patients with rheumatic disease who received outpatient treatment for COVID-19 infection.

“Some patients with systemic autoimmune rheumatic disease and immunosuppression might still be at risk of severe COVID-19,” the authors wrote. “The effect of outpatient SARS-CoV-2 treatments on COVID-19 outcomes among patients with systemic autoimmune rheumatic disease is unclear.”

To fill the gaps in understanding in this population, the investigates conducted a retrospective study of adult patients treated at Mass General Brigham Integrated Health Care system in Boston. Key endpoints included temporal trends, COVID-19 outcome severity, and COVID-19 rebound, compared between patients with pre-existing systematic rheumatic disease who received outpatient treatment and those who did not.

COVID-19 status was identified by a positive PCR or antigen test, and diagnosis codes and immunomodulator prescriptions were used to identify autoimmune rheumatic disease status. A medical record review identified whether outpatient SARS-CoV-2 treatments were administered. Severe COVID-19 was defined as hospitalization or death within 30 days of the positive test. Rebound was defined as documentation of a negative COVID-19 test after treatment followed by a newly positive test.

In total 704 patients were included; patients were treated between January 23 and May 30, 2022. The mean age was 58.4 years. Seventy-six percent of patients were female. Six percent of patients were Black, and 84% were White. Rheumatoid arthritis was confirmed in 49% of patients.

Of the total cohort, 61% received outpatient SARS-CoV-2 treatment. The authors noted that the use of these treatments increased in frequency over the study period (P<0.0001). Treatments administered were:

  • nirmatrelvir–ritonavir (44%)
    monoclonal antibodies (15%)
  • molnupiravir (1%)
    remdesivir (<1%)
  • combination treatment (1%)

Among the 426 patients who received outpatient treatment, there were 9 (2.1%) severe COVID-19 cases, compared with 49 (17.6%) cases among the 278 patients who did not receive the treatment (adjusted odds ratio: 0.12, 95% confidence interval: 0.05–0.25). Among a subgroup of 318 patients who received oral outpatient treatment, 25 (7.9%) had a documented COVID-19 rebound.

“Outpatient treatment was associated with lower odds of severe COVID-19 outcomes compared with no outpatient treatment,” summarized the authors. “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.”

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