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News from the programme area Epidemiology

Publications related to COVID-19

Evidence generation through national and global networks

The SARS-CoV-2 pandemic has left patients with rheumatic diseases in an uncertain situation as it was (and still is) unclear whether they are at particular risk of suffering a severe course of COVID-19 due to their immune-mediated disease or their immunomodulatory therapy.

This situation was also difficult for the treating rheumatologists, as they had to weigh the risk of disease flares with all their negative consequences for the patient against the risk of a possibly too strongly suppressed and weakened immune system. Decisions on treatment had to be made without comparable empirical values and could not be based on available data.

In view of this situation, the research group Pharmacoepidemiology has participated in the establishment of the German and European COVID-19 registries, which include patients with inflammatory rheumatic disease and SARS-CoV-2 infection. As of August 2020, 2,561 patients are included in the European (4,293 patients globally) and 373 patients in the German register. Through participation in the respective steering groups and evaluation and analyses of the data collected within the COVID-19 registries, researchers of the programme area Epidemiology are significantly involved in gaining knowledge on the special situation of patients with autoimmune diseases under immunosuppression.

The research group on Paediatric Rheumatology and Health services research has expanded the national database of the German collaborative arthritis centres of children and adolescents suffering from rheumatic diseases by two additional modules for recording SARS-CoV-2 infections and the SARS-CoV-2-associated hyperinflammation syndrome (MIS C for “multisystem inflammatory syndrome in children”). In August, fifteen children with rheumatic diseases and SARS-CoV-2 infections and four with MIS-C were registered nationwide. Further four cases with SARS-CoV-2 infections were recorded via the BiKeR register and the register of the German Society for Paediatric Infectiology, with which we cooperate. Together with the Universities of Potsdam and Ulm, the DRFZ has also acquired the Kick Covid research project, which analyses the long-term effects of the COVID-19 pandemic on the well-being and health care of children with chronic diseases associated with an increased risk of severe COVID-19 and their families.

Contact person at DRFZ:
PD Dr. med. Anja Strangfeld und PD Dr. med. Anne RegiererAG Pharmakoepidemiologie
Prof. Dr. med. Kirsten MindenAG Kinder- und Jugendrheumatologie

Publications from the programme area Epidemiology

Outcomes of SARS-CoV-2 infection among children and young people with pre-existing rheumatic and musculoskeletal diseases.  Kearsley-Fleet L, Chang ML, Lawson-Tovey S, Costello R, Fingerhutová Š, Švestková N, Belot A, Aeschlimann FA, Melki I, Koné-Paut I, Eulert S, Kallinich T, Berkun Y, Uziel Y, Raffeiner B, Oliveira Ramos F, Clemente D, Dackhammar C, Wulffraat NM, Waite H, Strangfeld A, Mateus EF, Machado PM; CARRA Registry Investigators; COVID-19 Global Pediatric Rheumatology Database Investigators, Natter M, Hyrich KL. Ann Rheum Dis. 2022 Jul;81(7):998-1005. doi: 10.1136/annrheumdis-2022-222241. Epub 2022 Mar 25. PMID: 35338032 Free PMC article.

SARS-CoV-2 vaccine safety in adolescents with inflammatory rheumatic and musculoskeletal diseases and adults with juvenile idiopathic arthritis: data from the EULAR COVAX physician-reported registry. Lawson-Tovey S, Machado PM, Strangfeld A, Mateus E, Gossec L, Carmona L, Raffeiner B, Bulina I, Clemente D, Zepa J, Rodrigues AM, Mariette X, Hyrich KL; EULAR COVAX. RMD Open. 2022 Jul;8(2):e002322. doi: 10.1136/rmdopen-2022-002322. PMID:  35908834 Free PMC article.

Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance. Ugarte-Gil MF, Alarcón GS, Izadi Z, Duarte-García A, Reátegui-Sokolova C, Clarke AE, Wise L, Pons-Estel GJ, Santos MJ, Bernatsky S, Ribeiro SLE, Al Emadi S, Sparks JA, Hsu TY, Patel NJ, Gilbert EL, Valenzuela-Almada MO, Jönsen A, Landolfi G, Fredi M, Goulenok T, Devaux M, Mariette X, Queyrel V, Romão VC, Sequeira G, Hasseli R, Hoyer B, Voll RE, Specker C, Baez R, Castro-Coello V, Maldonado Ficco H, Reis Neto ET, Ferreira GAA, Monticielo OAA, Sirotich E, Liew J, Hausmann J, Sufka P, Grainger R, Bhana S, Costello W, Wallace ZS, Jacobsohn L, Taylor T, Ja C, Strangfeld A, Mateus EF, Hyrich KL, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schäfer M, Machado PM, Robinson PC, Gianfrancesco M, Yazdany J. Ann Rheum Dis. 2022 Jul;81(7):970-978. doi: 10.1136/annrheumdis-2021-221636. Epub 2022 Feb 16. PMID: 35172961 Free PMC article.

Pausing methotrexate improves immunogenicity of COVID-19 vaccination in elderly patients with rheumatic diseases. Arumahandi de Silva AN, Frommert LM, Albach FN, Klotsche J, Scholz V, Jeworowski LM, Schwarz T, Ten Hagen A, Zernicke J, Corman VM, Drosten C, Burmester GR, Biesen R. Ann Rheum Dis. 2022 Jun;81(6):881-888. doi: 10.1136/annrheumdis-2021-221876. Epub 2022 Mar 14. PMID: 35288376 Free PMC article.

Safety of vaccination against SARS-CoV-2 in people with rheumatic and musculoskeletal diseases: results from the EULAR Coronavirus Vaccine (COVAX) physician-reported registry.  Machado PM, Lawson-Tovey S, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Rodrigues A, Raffeiner B, Duarte C, Hachulla E, Veillard E, Strakova E, Burmester GR, Yardımcı GK, Gomez-Puerta JA, Zepa J, Kearsley-Fleet L, Trefond L, Cunha M, Mosca M, Cornalba M, Soubrier M, Roux N, Brocq O, Durez P, Conway R, Goulenok T, Bijlsma JW, McInnes IB, Mariette X. Ann Rheum Dis. 2022 May;81(5):695-709. doi: 10.1136/annrheumdis-2021-221490. Epub 2021 Dec 31. PMID: 34972811 Free PMC article.

SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry. Liew J, Gianfrancesco M, Harrison C, Izadi Z, Rush S, Lawson-Tovey S, Jacobsohn L, Ja C, Hyrich KL, Gossec L, Strangfeld A, Carmona L, Schäfer M, Frãzao-Mateus E, Bulina I, Stafford F, Tufan A, Graver C, Yardımcı GK, Zepa J, Al Emadi S, Cook C, Abutiban F, Dey D, Katigbak G, Kaufman L, Kowalski E, Martínez-Martínez MU, Patel NJ, Reyes-Cordero G, Salido E, Smith E, Snow D, Sparks J, Wise L, Bhana S, Gore-Massy M, Grainger R, Hausmann J, Sirotich E, Sufka P, Wallace Z, Machado PM, Robinson PC, Yazdany J. RMD Open. 2022 Apr;8(1):e002187. doi: 10.1136/rmdopen-2021-002187. PMID: 35387864 Free PMC article.

Predictors of Serological Response to SARS-CoV-2 Vaccination in Kidney Transplant Patients: Baseline Characteristics, Immunosuppression, and the Role of IMPDH Monitoring. Liefeldt L, Glander P, Klotsche J, Straub-Hohenbleicher H, Budde K, Eberspächer B, Friedersdorff F, Halleck F, Hambach P, Hofmann J, Koch N, Schmidt D, Schrezenmeier E, Seelow E, Weber U, Zukunft B, Eckardt KU, Choi M, Bachmann F, Waiser J. J Clin Med. 2022 Mar 18;11(6):1697. doi: 10.3390/jcm11061697. PMID: 35330022 Free PMC article.

COVID-19 in Pregnant Women With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance. Bermas BL, Gianfrancesco M, Tanner HL, Seet AM, Aguiar MC, Al Adhoubi NK, Al Emadi S, Cunha BM, Flood R, Kusevich DA, McCarthy EM, Patel NJ, Ruderman EM, Sattui SE, Sciascia S, Siddique F, Valenzuela-Almada MO, Wise LM, Worthing AB, Zell J, Bhana S, Costello W, Duarte-Garcia A, Grainger R, Gossec L, Hausmann JS, Hyrich K, Lawson-Tovey S, Liew JW, Sirotich E, Sparks JA, Sufka P, Wallace ZS, Machado PM, Strangfeld A, Clowse MEB, Yazdany J, Robinson PC. J Rheumatol. 2022 Jan;49(1):110-114. doi: 10.3899/jrheum.210480. Epub 2021 Sep 1. PMID: 34470798.

SARS-CoV-2 infection after vaccination in patients with inflammatory rheumatic and musculoskeletal diseases. Lawson-Tovey S, Hyrich KL, Gossec L, Strangfeld A, Carmona L, Raffeiner B, Yardımcı GK, Trefond L, Roux N, Rodrigues A, Papagoras C, Mateus EF, Mariette X, Machado PM. Ann Rheum Dis. 2022 Jan;81(1):145-150. doi: 10.1136/annrheumdis-2021-221217. Epub 2021 Sep 6. PMID: 34489305 No abstract available.

Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic, including recommendations for COVID-19 vaccination. Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. Z Rheumatol. 2021 Dec;80(Suppl 2):33-48. doi: 10.1007/s00393-021-01055-7. Epub 2021 Sep 7. PMID: 34491403 Free PMC article. Review. No abstract available.

TNFi is associated with positive outcome, but JAKi and rituximab are associated with negative outcome of SARS-CoV-2 infection in patients with RMD. Regierer AC, Hasseli R, Schäfer A, Hoyer BF, Krause A, Lorenz HM, Pfeil A, Richter J, Schmeiser T, Schulze-Koops H, Strangfeld A, Voll RE, Specker C, Mueller-Ladner U.RMD Open. 2021 Oct;7(3):e001896. doi: 10.1136/rmdopen-2021-001896.PMID: 34670840.

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Strangfeld A, Schäfer A, Gianfrancesco MA, Lawson-Tovey S, Liew JW, Ljung L, Mateus EF, Richez C, Santos MJ, Schmajuk G, Scirè CA, Sirotich E, Sparks JA, Sufka P, Thomas T, Trupin L, Wallace ZS, Al-Adely S, Bachiller-Corral J, Bhana S, Cacoub P, Carmona L, Costello R, Costello W, Gossec L, Grainger R, Hachulla E, Hasseli R, Hausmann JS, Hyrich KL, Izadi Z, Jacobsohn L, Katz P, Kearsley-Fleet L, Robinson PC, Yazdany J, Machado PM; COVID-19 Global Rheumatology Alliance. Ann Rheum Dis. 2021 Jul;80(7):930-942. doi: 10.1136/annrheumdis-2020-219498.

Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study.Sattui SE, Conway R, Putman MS, Seet AM, Gianfrancesco MA, Beins K, Hill C, Liew D, Mackie SL, Mehta P, Neill L, Gomez G, Salinas MIH, Maldonado FN, Mariz HA, de Sousa Studart SA, Araujo NC, Knight A, Rozza D, Quartuccio L, Samson M, Bally S, Maria AT, Chazerain P, Hasseli R, Müller-Ladner U, Hoyer BF, Voll R, Torres RP, Luis M, Ribeirio SLE, Al-Emadi S, Sparks JA, Hsu TY, D’Silva KM, Patel NJ, Wise L, Gilbert E, Almada MV, Duarte-García A, Ugarte-Gil M, Jacobsohn L, Izadi Z, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Sirotich E, Hausmann JS, Sufka P, Bhana S, Liew JW, Grainger R, Machado PM, Wallace ZS, Yazdany J, Robinson PC; Global Rheumatology Alliance. Lancet Rheumatol. 2021 Dec;3(12):e855-e864. doi: 10.1016/S2665-9913(21)00316-7. Epub 2021 Nov 5. PMID: 34778843 Free PMC article.

Association Between Tumor Necrosis Factor Inhibitors and the Risk of Hospitalization or Death Among Patients With Immune-Mediated Inflammatory Disease and COVID-19. Izadi Z, Brenner EJ, Mahil SK, Dand N, Yiu ZZN, Yates M, Ungaro RC, Zhang X, Agrawal M, Colombel JF, Gianfrancesco MA, Hyrich KL, Strangfeld A, Carmona L, Mateus EF, Lawson-Tovey S, Klingberg E, Cuomo G, Caprioli M, Cruz-Machado AR, Mazeda Pereira AC, Hasseli R, Pfeil A, Lorenz HM, Hoyer BF, Trupin L, Rush S, Katz P, Schmajuk G, Jacobsohn L, Seet AM, Al Emadi S, Wise L, Gilbert EL, Duarte-García A, Valenzuela-Almada MO, Isnardi CA, Quintana R, Soriano ER, Hsu TY, D’Silva KM, Sparks JA, Patel NJ, Xavier RM, Marques CDL, Kakehasi AM, Flipo RM, Claudepierre P, Cantagrel A, Goupille P, Wallace ZS, Bhana S, Costello W, Grainger R, Hausmann JS, Liew JW, Sirotich E, Sufka P, Robinson PC, Machado PM, Griffiths CEM, Barker JN, Smith CH, Yazdany J, Kappelman MD; Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect); the Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD); and the COVID-19 Global Rheumatology Allianc; Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect); the Secure Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD); and the COVID-19 Global Rheumatology Alliance (GRA). JAMA Netw Open. 2021 Oct 1;4(10):e2129639. doi: 10.1001/jamanetworkopen.2021.29639. PMID: 34661663.

[German registry www.Covid19-Rheuma.de : Status report after 1 year of the pandemic]. Hasseli R, Pfeil A, Hoyer BF, Lorenz HM, Regierer AC, Richter JG, Schmeiser T, Strangfeld A, Voll RE, Krause A, Schulze-Koops H, Müller-Ladner U, Specker C. Z Rheumatol. 2021 Sep;80(7):641-646. doi: 10.1007/s00393-021-01034-y. Epub 2021 Jul.

EULAR COVID-19 registry: lessons learnt and future considerations. Lawson-Tovey S, Strangfeld A, Hyrich KL, Carmona L, Rodrigues D, Gossec L, Mateus EF, Machado PM. Ann Rheum Dis. 2021 Sep;80(9):1110-1115. doi: 10.1136/annrheumdis-2021-220319. Epub 2021 Apr 27.

Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry. Sparks JA, Wallace ZS, Seet AM, Gianfrancesco MA, Izadi Z, Hyrich KL, Strangfeld A, Gossec L, Carmona L, Mateus EF, Lawson-Tovey S, Trupin L, Rush S, Katz P, Schmajuk G, Jacobsohn L, Wise L, Gilbert EL, Duarte-García A, Valenzuela-Almada MO, Pons-Estel GJ, Isnardi CA, Berbotto GA, Hsu TY, D’Silva KM, Patel NJ, Kearsley-Fleet L, Schäfer A, Ribeiro SLE, Al Emadi S, Tidblad L, Scirè CA, Raffeiner B, Thomas T, Flipo RM, Avouac J, Seror R, Bernardes M, Cunha MM, Hasseli R, Schulze-Koops H, Müller-Ladner U, Specker C, Souza VA, Mota LMHD, Gomides APM, Dieudé P, Nikiphorou E, Kronzer VL, Singh N, Ugarte-Gil MF, Wallace B, Akpabio A, Thomas R, Bhana S, Costello W, Grainger R, Hausmann JS, Liew JW, Sirotich E, Sufka P, Robinson PC, Machado PM, Yazdany J; COVID-19 Global Rheumatology Alliance. Ann Rheum Dis. 2021 Sep;80(9):1137-1146. doi: 10.1136/annrheumdis-2021-220418. Epub 2021 May 28.

Clinical manifestations and outcome of SARS-CoV-2 infections in children and adolescents with rheumatic musculoskeletal diseases: data from the National Paediatric Rheumatology Database in Germany. Sengler C, Eulert S, Minden K, Niewerth M, Horneff G, Kuemmerle-Deschner J, Siemer C, Berendes R, Girschick H, Hühn R, Borte M, Hospach A, Emminger W, Armann J, Klein A, Kallinich T. RMD Open. 2021 Jul;7(2):e001687. doi: 10.1136/rmdopen-2021-001687. PMID: 34312307.

Response to: ‘Correspondence on ‘Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician reported registry” by Mulhearn et al. Schäfer A, Strangfeld A, Hyrich KL, Carmona L, Gianfrancesco M, Lawson-Tovey S, Mateus EF, Gossec L, Robinson PC, Yazdany J, Machado PM. Ann Rheum Dis. 2021 Mar 1:annrheumdis-2021-220134. doi: 10.1136/annrheumdis-2021-220134. Online ahead of print.

Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases. Hasseli R, Mueller-Ladner U, Hoyer BF, Krause A, Lorenz HM, Pfeil A, Richter J, Schäfer A, Schmeiser T, Strangfeld A, Schulze-Koops H, Voll RE, Specker C, Regierer AC. RMD Open. 2021 Jan;7(1):e001464. doi: 10.1136/rmdopen-2020-001464.

National registry for patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 in Germany (ReCoVery): a valuable mean to gain rapid and reliable knowledge of the clinical course of SARS-CoV-2 infections in patients with IRD. Hasseli R, Müller-Ladner U, Schmeiser T, Hoyer B, Krause A, Lorenz HM, Regierer AC, Richter JG, Strangfeld A, Voll RE, Pfeil A, Schulze-Koops H, Specker C. RMD Open 2020:6:e001332. doi:10.1136/rmdopen-2020-001332.

[COVID-19: treatment strategies of German-speaking pediatric rheumatologists : Results of an online survey].Janda A, Schuetz C, Heeg M, Minden K, Hedrich CM, Kallinich T, Hinze C, Schulz A, Speth F.Z Rheumatol. 2020 Aug 18:1-8. doi: 10.1007/s00393-020-00854-8. Online ahead of print.

Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, Izadi Z, Jacobsohn L, Katz P, Lawson-Tovey S, Mateus EF, Rush S, Schmajuk G, Simard J, Strangfeld A, Trupin L, Wysham KD, Bhana S, Costello W, Grainger R, Hausmann JS, Liew JW, Sirotich E, Sufka P, Wallace ZS, Yazdany J, Machado PM, Robinson PC; COVID-19 Global Rheumatology Alliance.Ann Rheum Dis. 2020 Jul;79(7):859-866. doi: 10.1136/annrheumdis-2020-217871.

Rheumatic disease and COVID-19: initial data from the COVID-19 Global Rheumatology Alliance provider registries. Gianfrancesco MA, Hyrich KL, Gossec L, Strangfeld A, Carmona L, Mateus EF, Sufka P, Grainger R, Wallace Z, Bhana S, Sirotich E, Liew J, Hausmann JS, Costello W, Robinson P, Machado PM, Yazdany J; COVID-19 Global Rheumatology Alliance Steering Committee.Lancet Rheumatol. 2020 May;2(5):e250-e253. doi: 10.1016/S2665-9913(20)30095-3.

COVID-19 registry in rheumatology

COVID-19 registry in rheumatology for children

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