Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 global rheumatology alliance

Manuel Francisco Ugarte-Gil, Graciela S. Alarcón, Zara Izadi, Ali Duarte-García, Cristina Reátegui-Sokolova, Ann Elaine Clarke, Leanna Wise, Guillermo J. Pons-Estel, Maria Jose Santos, Sasha Bernatsky, Sandra Lúcia Euzébio Ribeiro, Samar Al Emadi, Jeffrey A. Sparks, Tiffany Y.T. Hsu, Naomi J. Patel, Emily L. Gilbert, Maria O. Valenzuela-Almada, Andreas Jönsen, Gianpiero Landolfi, Micaela FrediTiphaine Goulenok, Mathilde Devaux, Xavier Mariette, Viviane Queyrel, Vasco C. Romão, Graca Sequeira, Rebecca Hasseli, Bimba Hoyer, Reinhard E. Voll, Christof Specker, Roberto Baez, Vanessa Castro-Coello, Hernan Maldonado Ficco, Edgard Torres Reis Neto, Gilda Aparecida Aparecida Ferreira, Odirlei Andre André Monticielo, Emily Sirotich, Jean Liew, Jonathan Hausmann, Paul Sufka, Rebecca Grainger, Suleman Bhana, Wendy Costello, Zachary S. Wallace, Lindsay Jacobsohn, Tiffany Taylor, Clairissa Ja, Anja Strangfeld, Elsa F. Mateus, Kimme L. Hyrich, Loreto Carmona, Saskia Lawson-Tovey, Lianne Kearsley-Fleet, Martin Schäfer, Pedro M. MacHado, Philip C. Robinson, Milena Gianfrancesco, Jinoos Yazdany

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57 Scopus citations


Aim To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19. Methods People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity. Results A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1-5 mg/day 1.86, 1.20 to 2.66, 6-9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab. Conclusions More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.

Original languageEnglish
Pages (from-to)970-978
Number of pages9
JournalAnnals of the Rheumatic Diseases
Issue number7
StatePublished - 2022

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