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Patients with dermatomyositis may be protected from various aspects of COVID-19. However, certain subgroups of patients with dermatomyositis (DM), including those who were older, Black, or had a history of interstitial lung disease, were found to be at greater risk for severe COVID-19, according to data from a retrospective registry-based cohort analysis published in Seminars in Arthritis & Rheumatism.
Investigators analyzed retrospective data from the TriNetX Research Network databaseand included adult patients with and without DM who were diagnosed with COVID-19 from January 2020 to August 2021. They used 1:1 propensity score matching to adjust for confounding factors. COVID-19 outcomes of mortality, hospitalization, ICU admission, severe COVID-19, mechanical ventilation need, acute kidney injury (AKI), venous thromboembolism (VTE), ischemic stroke, acute respiratory distress syndrome (ARDS), renal replacement therapy (RRT), and sepsis were assessed.
There were 5574 patients with DM and COVID-19 and 5574 patients with only COVID-19 (control patients). The mean age for both groups was about 58 years, about 78% of both groups were women and about 75% of both groups were White.
Patients with DM and COVID-19 had a lower risk for mortality (RR, 0.76), hospitalization (RR, 0.8), severe COVID-19 (RR, 0.76), AKI (RR, 0.83), and sepsis (RR, 0.73). Men and African Americans with DM and COVID-19 were more likely to develop AKI (RR, 1.35), and African Americans with DM and COVID-19 were more likely to develop severe COVID-19 (RR, 1.62) and VTE (RR, 1.54). Patients with DM and interstitial lung disease also had a greater risk of having severe COVID-19 (RR, 1.64) and VTE (RR, 2.06). Patients with DM receiving DMARDs and glucocorticoids were at higher risk of being hospitalized (RR, 1.46 and 2.12) and developing sepsis (RR, 3.25 and 2.4).
When matched for sex, the only significant difference found was that men with DM and COVID-19 were more likely to develop AKI compared with women (8.5% vs 6.3%; aRR, 1.35). When matched by race, Black patients with DM and COVID-19 were more likely to be hospitalized, require mechanical ventilation, and have severe COVID-19 compared with their White counterparts, but there was no significant difference in mortality rate between the 2 races.
The study was limited by the limitations of the TriNetX database such as nondisclosure of health care organizations and unvalidated quality of the data entered.
The study authors highlighted the surprising finding that DM was associated with a decreased risk of some COVID-19 outcomes, positing that the use of certain immunosuppressive medications in DM patients may be protective against the COVID-19 cytokine storm.
“Thus the identification on what kind of immunosuppressants can be protective against COVID-19 should be further investigated,” the study authors wrote.
Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Blauvelt A, Guttman-Yassky E, Paller AS, et al. Long-term efficacy and safety of dupilumab in adolescents with moderate-to-severe atopic dermatitis: Results through week 52 from a phase III open-label extension trial (LIBERTY AD PED-OLE).Am J Clin Dermatol. 2022;23(3):365-383. doi:10.1007/s40257-022-00683-2
