AB1136 PREVALENCE OF COVID-19 IN SYSTEMIC LUPUS ERYTHEMATOSUS: A META-ANALYSIS

Abstract

BackgroundNovel Coronavirus pneumonia 2019 (COVID-19) is a systemic infectious disease with prominent involvement of the respiratory tract, due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)[1]. Systemic lupus erythematosus is charcterized by an aberrant immune response with the presence of circulating autoantibodies, lymphopenia, and proinflammatory[2]. They are immune-compromised and vulnerable to infections with immune-suppressants treatment. However, data regarding the impact of COVID-19 pandemic in patients with SLE and drug use were relatively scarce.ObjectivesThe prevalence of COVID-19 in SLE patients was estimated by means of meta-analysis, and the effect of the use of anti-rheumatic drugs on the clinical outcome of SLE patients with COVID-19 was investigated.MethodsCross-sectional investigations and case series on SLE and COVID-19 published by CBM, CNKI, China Science and Technology Journal Database, Wan Fang Data, PubMed, Embase, Web of Science, Cochrane Library and Medline from its establishment to November 10, 2021 were searched. Random effects model was used to pool data. Heterogeneity and risk of bias was examined with I-squared index (I2) statistic. Inconsistency was evaluated by using the I2. Egger tests were used for the evaluation of potential publication bias (STATA v.12.0).ResultsA total of 14 studies comprising 5365 patients were identified (Table 1). Overall prevalence of COVID-19 in SLE patients was 1.5% (95%CI: 1.2%-1.8%). Eight of the studies included patients who used hydroxychloroquine as part of their treatment regimen, with 29.8% (95%CI: 25.8%-33.8%) hospitalization rates and 14.6% (95%CI: 11.5%-17.8%) adverse outcome rates. Among patients treated with hydroxychloroquine throughout the course of disease, the prevalence was 0.7% (95%CI: 0.4%-1.0%, Figure 1).Table 1.Summary of study characteristics of included records.AuthorTotal number of patientsMean/Median AgeHCQOther therapeutic drugsNumber of COVID19(n)Mean/Median AgeHCQOther therapeutic drugsHospitalization(n)supplemental oxyge(n)Combined poor outcomesGerard Espinosa40050.7GCs:47447.922GCs:12,T-DMARD:28,others:13334Emanuele Bozzalla Cassione16552.5127T-DMARD:12,others:411252.53GCs:1,others:31Ren: Cordtz253355.41170GCs:685,B-DMARD:42,T-DMARD:374,others:9261669.15GCs:416Ruth Fernandez-Ruiz226834332GCs:18,T-DMARD:5,others:5024198Zos Gendebien22551.7152GCs:92,T-DMARD:25,others:523222Wendy Wan Hui Lee8538.2858GCs:54,others:502311Giuseppe A. Ramirez, MD417others:389,combination:2891411Samar Tharwat20030.1140GCs:174,B-DMARD:4,T-DMARD:310,others:18432Dina Zucchi33247267GCs:176,B-DMARD:41,T-DMARD:118,others:118,combination:112640.36GCs:6,T-DMARD:1,others:6311Sarthak Gupta177GCs:81746.11GCs:12,T-DMARD:31022Seow Lin Chuah181838uah67Claudia Diniz Lopes Marques11033445 (31ques118GCs:134,T-DMARD:110,others:2841103578Beth Wallace31616GCs:12,others:4554 (26-67)4GCs:4,others:355Isabela Maria Bertoglio38245.138245.5206173Figure 1.A:Forest map of a meta-analysis of COVID-19 prevalence in SLE patients.B: Forest map of a meta-analysis of hospitalization rates among patients treated with hydroxychloroquine.C:Forest map of meta-analysis of the rate of adverse outcomes in patients using hydroxychloroquine as part of a treatment regimen.D:Forest map of a meta-analysis of the prevalence of patients treated with hydroxychloroquine throughout the course.ConclusionPatients with SLE had a higher risk of COVID-19. Hydroxychloroquine might benefit to reduce the overall hospitalization rate and prevalence rate of COVID-19, and alleviate inflammatory damage in the chronic stage of viral infection by inhibiting over activation of the immune system.