Letters to the Editor
Factors associated with mortality in lupus during the COVID-19 pandemic
Carlos Alfonso González-Gómeza
a Especialista en Medicina Interna, Fellow de Reumatología. Servicio de Reumatología, Departamento de Medicina Interna. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC). Buenos Aires, Argentina. E-Mail: carlosagg30@gmail.com
Dear Editor
I read with great interest the article titled "COVID-19 in patients with systemic lupus erythematosus and mortality." I believe it is appropriate to clarify some of the statements made by Alva-Arroyo et al. 1. During the SARS-CoV-2 pandemic, the Global Rheumatol ogy Alliance registry was developed. This registry characterized patients with autoimmune diseases who had COVID-19 early on in the pandemic. As early as 2020, it was established that exposure to more than 10 mg/day of corticosteroids increased the likelihood of hospitalization 2.
Using the Global Rheumatology Alliance registry, Ugarte-Gil et al. analyzed 1,606 people with systemic lupus erythematosus and found that older age, male sex, taking corticosteroids, not currently receiving treatment, and having comorbidities (chronic kidney disease, cardiovascular disease/hypertension and high systemic lupus erythematosus [SLE] activity) were associated with more serious outcomes. Treatment with mycophenolate, rituximab and cyclophosphamide proved to have worse outcomes 3.
Baricitinib has not been shown to increase COVID-19 severity and has been proposed as an effective treatment which, together with remdesivir, has proven to reduce recovery treatment and accelerate clinical improvement in patients hospitalized for COVID-19 4.
It is unlikely that the mortality in this case series was related to the use of baricitinib or the presence of lupus nephropathy, and therefore it is important to intensify treatment so that patients with SLE can achieve low activity/remission of the disease and control comorbidi ties to avoid the severe form.
References
1. Alva Arroyo NV, Hernández-Sánchez N, Gasca-Aldama JC, Salvador-Ibarra I. COVID-19 en pacientes con lupus eritematoso sistémico y mortalidad. Acta Med Col [Internet]. 2022 Feb 3 [cited 2022 Dec 19];47(4). Available from: Available from: http://actamedicacolombiana.com/ojs/index.php/actamed/article/view/2551
[ Links ]
2. Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, Izadi Z, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis [Internet]. 2020 Jul [cited 2022 Dec 19];79(7):859-866. Available from: Available from: https://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2020-217871
[ Links ]
3. Ugarte-Gil MF, Alarcón GS, Izadi Z, Duarte-García A, Reátegui-Sokolova C, Clarke AE, Wise L, et al. Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance. Ann Rheum Dis [Internet]. 2022 Jul [cited 2022 Dec 19];81(7):970-978. Available from: Available from: https://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2021-221636
[ Links ]
4. Kalil AC, Patterson TF, Mehta AK, Tomashek KM, Wolfe CR, Ghazaryan V, Marconi VC, et al. Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19. N Engl J Med [Internet]. 2021 Mar 4 [cited 2022 Dec 19];384(9):795-807. Available from: Available from: http://www.nejm.org/doi/10.1056/NEJMoa2031994
[ Links ]
Different pharmacological treatments, including baricitinib, were generated during the pandemic with the aim of decreasing mortality. However, despite what is described in this letter to the editor, baricitinib appears to be a confounding variable. As is clearly shown in the table of general characteristics, patients who were prescribed an 8 mg dose by their rheumatologist survived, unlike those with a 4 mg dose, although it is true that it is a case series. I should point out that we did not have access to remdesivir in Mexico; therefore, the multidisciplinary consensus treatment was an 8 mg dose, and they were shown to survive, although it should be noted that the two patients who died had the vaccine and the two who survived did not. All of these patients were in catastrophic settings like the pandemic, and more patients were needed in our population to meet the calculated sample size to show statistical power in determining the dose-response relationship; however the pandemic ended and no further patients were recruited.
Durante la pandemia se suscitaron diferentes manejos farmacológicos con la finalidad de disminuir la mortalidad, entre ellos el baricitinib, sin embargo, a pesar de los descrito en esta carta al editor, parecería una variable confusora el baricitinib, como bien se demuestra en la tabla de características generales, los pacientes que por indicación de un reumatólogo, recibieron 8 mg de dosis sobrevivieron a diferencia de los de 4 mg, si bien es cierto es una serie de casos; debo resaltar que en México no contábamos con acceso a remdesivir, por lo tanto, el manejo en consenso multidisiciplinario fue dosis de 8 mg y se demostró que sobrevivieron, si bien, cabe resaltar que los dos pacientes que fallecieron contaban con inumnización y los dos que sobrevivieron no contaban con vacuna. Todos en escenarios catastróficos como fue la pandemia vivida, la relación dosis de baricitinib, de acuerdo a que se necesitaban más pacientes en nuestra población con cálculo de muestra para poder demostrar un poder estadístico; sin embargo, finalizó la pandemia y no se reclutaron más pacientes.
texto em 
Inglês (pdf)
Artigo em XML
Referências do artigo
Tradução automática
Enviar este artigo por email
Citado por SciELO 
Citado por Google 
Similares em
SciELO 
Similares em Google 
Permalink
