Title:Prevalence and Death Rate of COVID-19 in Autoimmune Systemic Diseases in the
First Three Pandemic Waves. Relationship with Disease Subgroups and Ongoing
Therapies
Volume: 28
Issue: 24
Author(s): Clodoveo Ferri*, Vincenzo Raimondo, Laura Gragnani, Dilia Giuggioli, Lorenzo Dagna, Antonio Tavoni, Francesco Ursini, Massimo L'Andolina, Francesco Caso, Piero Ruscitti, Maurizio Caminiti, Rosario Foti, Valeria Riccieri, Serena Guiducci, Roberta Pellegrini, Elisabetta Zanatta, Giuseppe Varcasia, Domenico Olivo, Pietro Gigliotti, Giovanna Cuomo, Giuseppe Murdaca, Riccardo Cecchetti, Rossella De Angelis, Nicoletta Romeo, Francesca Ingegnoli, Franco Cozzi, Veronica Codullo, Ilaria Cavazzana, Michele Colaci, Giuseppina Abignano, Maria De Santis, Ennio Lubrano, Enrico Fusaro, Amelia Spinella, Federica Lumetti, Giacomo De Luca, Silvia Bellando-Randone, Elisa Visalli, Ylenia Dal Bosco, Giorgio Amato, Daiana Giannini, Silvia Bilia, Francesco Masini, Greta Pellegrino, Erika Pigatto, Elena Generali, Giuseppa Pagano Mariano, Giorgio Pettiti, Giovanni Zanframundo, Raffaele Brittelli, Vincenzo Aiello, Rodolfo Caminiti, Daniela Scorpiniti, Tommaso Ferrari, Corrado Campochiaro, Veronica Brusi, Micaela Fredi, Liala Moschetti, Fabio Cacciapaglia, Sabrina Rosaria Paparo, Francesca Ragusa, Valeria Mazzi, Giusy Elia, Silvia Martina Ferrari, Ilenia Di Cola, Marta Vadacca, Sebastiano Lorusso, Monica Monti, Serena Lorini, Maria Letizia Aprile, Marco Tasso, Mario Miccoli, Silvia Bosello, Salvatore D'Angelo, Andrea Doria, Franco Franceschini, Riccardo Meliconi, Marco Matucci-Cerinic, Florenzo Iannone, Roberto Giacomelli, Carlo Salvarani, Anna Linda Zignego, Poupak Fallahi and Alessandro Antonelli*
Affiliation:
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
- Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, Crotone, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
Keywords:
COVID-19, autoimmune systemic diseases, systemic sclerosis, vasculitis, interstitial lung involvement, steroids, DMARD, aspirin.
Abstract:
Objective: Autoimmune systemic diseases (ASD) represent a predisposing condition to COVID-19.
Our prospective, observational multicenter telephone survey study aimed to investigate the prevalence, prognostic
factors, and outcomes of COVID-19 in Italian ASD patients.
Methods: The study included 3,918 ASD pts (815 M, 3103 F; mean age 59±12SD years) consecutively recruited
between March 2020 and May 2021 at the 36 referral centers of COVID-19 and ASD Italian Study Group.
The possible development of COVID-19 was recorded by means of a telephone survey using a standardized
symptom assessment questionnaire.
Results: ASD patients showed a significantly higher prevalence of COVID-19 (8.37% vs. 6.49%; p<0.0001)
but a death rate statistically comparable to the Italian general population (3.65% vs. 2.95%). Among the 328 ASD patients developing COVID-19, 17% needed hospitalization, while mild-moderate manifestations were
observed in 83% of cases. Moreover, 12/57 hospitalized patients died due to severe interstitial pneumonia
and/or cardiovascular events; systemic sclerosis (SSc) patients showed a significantly higher COVID-19-related
death rate compared to the general population (6.29% vs. 2.95%; p=0.018). Major adverse prognostic factors to
develop COVID-19 were: older age, male gender, SSc, pre-existing ASD-related interstitial lung involvement,
and long-term steroid treatment. Of note, patients treated with conventional synthetic disease-modifying antirheumatic
drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those
without (3.58% vs. 46.99%; p=0.000), as well as the SSc patients treated with low dose aspirin (with 5.57% vs.
without 27.84%; p=0.000).
Conclusion: During the first three pandemic waves, ASD patients showed a death rate comparable to the general
population despite the significantly higher prevalence of COVID-19. A significantly increased COVID-19-
related mortality was recorded in only SSc patients’ subgroup, possibly favored by preexisting lung fibrosis.
Moreover, ongoing long-term treatment with csDMARDs in ASD might usefully contribute to the generally
positive outcomes of this frail patients’ population.
