AB0094 RISK OF SEVERE COVID-19 IN PATIENTS WITH RHEUMATOID ARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES
Authors: P. Paramiraksa, M. Boonsiri, P. Patthamalai, A. Tansawet
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Increasing evidence has reported the risk of severe coronavirus disease (COVID-19) among patients with rheumatoid arthritis (RA). However, the discrepancy remains amongst studies. <h3>Objectives:</h3> We performed a systematic review and meta-analysis of cohort studies to quantify the magnitude of the association between RA and risk of severe COVID-19 outcomes. <h3>Methods:</h3> A systematic search was performed in the MEDLINE, Scopus, EMBASE, Cochrane Library, and medRxiv to identify relevant studies published from inception to January 2024. The eligibility criteria are cohort studies examining the risk of severe COVID-19 outcomes amongst patients with RA versus controls with no underlying RA. Quality assessments were performed according to the Newcastle-Ottawa Scale (NOS). Two authors independently screened relevant studies, extracted data, and evaluated study quality. If consensus is required, a third reviewer will be consulted. The PRISMA and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. To minimize the confounder effect, only adjusted hazard ratio (aHR), not crude HR, from the model adjusted for potential confounders were selected and pooled using the random-effects meta-analysis. Publication bias was evaluated by funnel plot. <h3>Results:</h3> A total of 3 cohort studies with 4,639,846 participants met the eligible criteria and were included in the meta-analysis. The pooled aHR revealed that the underlying condition of RA was significantly associated with an increased risk of severe COVID-19 with no heterogeneity (pooled aHR, 1.35; 95% CI, 1.12-1.62; I<sup>2</sup> = 0%). <h3>Conclusion:</h3> Patients with RA are at higher risk of severe COVID-19 outcomes compared to those without RA. These findings suggest that RA patients should receive proper management and close monitoring when infected with COVID-19. However, additional well-designed cohort studies are warranted to validate these findings and recommendations. <h3>REFERENCES:</h3> [1] Figueroa-Parra G, Gilbert EL, Valenzuela-Almada MO, Vallejo S, Neville MR, Patel NJ, et al. Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: A retrospective, comparative, Multicentre cohort study. The Lancet Rheumatology. 2022;4(11). doi:10.1016/s2665-9913(22)00227-2. [2] England BR, Roul P, Yang Y, Kalil AC, Michaud K, Thiele GM, et al. Risk of COVID-19 in rheumatoid arthritis: A National Veterans Affairs matched cohort study in at-risk individuals. Arthritis &amp;amp; Rheumatology. 2021;73(12):2179–88. doi:10.1002/art.41800. [3] Cordtz R, Lindhardsen J, Soussi BG, Vela J, Uhrenholt L, Westermann R, et al. Incidence and severeness of COVID-19 hospitalization in patients with inflammatory rheumatic disease: A nationwide cohort study from Denmark. Rheumatology. 2020;60(SI). doi:10.1093/rheumatology/keaa897. [4] Stroup, D. F. (2000). Meta-analysis of observational studies in epidemiology&lt;subtitle&gt;A proposal for reporting&lt;/subtitle&gt;. <i>JAMA</i>, <i>283</i>(15), 2008. https://doi.org/10.1001/jama.283.15.2008. [5] Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The Prisma 2020 statement: An updated guideline for reporting systematic reviews. <i>BMJ</i>. https://doi.org/10.1136/bmj.n71. [6] EYUPOGLU OE. "the relationship between rheumatoid arthritis and covid-19." Biomedical Journal of Scientific &amp;amp; Technical Research. 2021;38(4). doi:10.26717/bjstr.2021.38.006177. [7] Kandimalla R, Dewanjee S, Kalra RS, Valupadas C, Vallamkondu J, Kolli V, et al. Covid-19 and rheumatoid arthritis crosstalk: Emerging Association, Therapeutic Options, and challenges. 2021; doi:10.31219/osf.io/pzehv. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>