AUTHOR=Cruz-Machado Ana Rita , Barreira Sofia C. , Bandeira Matilde , Veldhoen Marc , Gomes Andreia , Serrano Marta , Duarte Catarina , Rato Maria , Miguel Fernandes Bruno , Garcia Salomé , Pinheiro Filipe , Bernardes Miguel , Madeira Nathalie , Miguel Cláudia , Torres Rita , Bento Silva Ana , Pestana Jorge , Almeida Diogo , Mazeda Carolina , Cunha Santos Filipe , Pinto Patrícia , Sousa Marlene , Parente Hugo , Sequeira Graça , Santos Maria José , Fonseca João Eurico , Romão Vasco C. TITLE=Risk Factors for Infection, Predictors of Severe Disease, and Antibody Response to COVID-19 in Patients With Inflammatory Rheumatic Diseases in Portugal—A Multicenter, Nationwide Study JOURNAL=Frontiers in Medicine VOLUME=9 YEAR=2022 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.901817 DOI=10.3389/fmed.2022.901817 ISSN=2296-858X ABSTRACT=Objective

To identify risk factors for SARS-CoV-2 infection and for severe/critical COVID-19, and to assess the humoral response after COVID-19 in these patients.

Methods

Nationwide study of adult patients with inflammatory RMDs prospectively followed in the Rheumatic Diseases Portuguese Register—Reuma.pt—during the first 6 months of the pandemic. We compared patients with COVID-19 with those who did not develop the disease and patients with mild/moderate disease with those exhibiting severe/critical COVID-19. IgG antibodies against SARS-CoV-2 were measured ≥3 months after infection and results were compared with matched controls.

Results

162 cases of COVID-19 were registered in a total of 6,363 appointments. Patients treated with TNF inhibitors (TNFi; OR = 0.160, 95% CI 0.099–0.260, P < 0.001) and tocilizumab (OR 0.147, 95% CI 0.053–0.408, P < 0.001) had reduced odds of infection. Further, TNFi tended to be protective of severe and critical disease. Older age, major comorbidities, and rituximab were associated with an increased risk of infection and worse prognosis. Most patients with inflammatory RMDs (86.2%) developed a robust antibody response. Seroconversion was associated with symptomatic disease (OR 13.46, 95% CI 2.21–81.85, P = 0.005) and tended to be blunted by TNFi (OR 0.17, 95% CI 0.03–1.05; P = 0.057).

Conclusions

TNFi and tocilizumab reduced the risk of infection by SARS-CoV-2. Treatment with TNFi also tended to reduce rates of severe disease and seroconversion. Older age, general comorbidities and rituximab were associated with increased risk for infection and worse prognosis, in line with previous reports. Most patients with RMDs developed a proper antibody response after COVID-19, particularly if they had symptomatic disease.