Реферат
OBJECTIVES: To evaluate risk factors for severe Coronavirus Disease 2019 (COVID-19) in patients with immune-mediated rheumatic diseases, stratified by systemic autoimmune conditions and chronic inflammatory arthritis. METHODS: An observational, cross-sectional multicenter study was performed. Patients from 10 Rheumatology departments in Madrid who presented with SARS-CoV-2 infection between Feb 2020 and May 2021 were included. The main outcome was COVID-19 severity (hospital admission or mortality). Risk factors for severity were estimated, adjusting for covariates (sociodemographic, clinical and treatments), using logistic regression analyses. RESULTS: 523 patients with COVID-19 were included, among whom 192 (35.6%) patients required hospital admission and 38 (7.3%) died. Male gender, older age and comorbidities such as diabetes mellitus, hypertension and obesity were associated with severe COVID-19. Corticosteroid doses over 10 mg/day, rituximab, sulfasalazine and mycophenolate use, were independently associated with worse outcomes. COVID-19 severity decreased over the different pandemic waves. Mortality was higher in the systemic autoimmune conditions (univariate analysis, p<0.001), although there were no differences in overall severity in the multivariate analysis. CONCLUSIONS: This study confirms and provides new insights regarding the harmful effects of corticosteroids, rituximab and other therapies (mycophenolate and sulfasalazine) in COVID-19. Methotrexate and anti-TNF therapy were not associated with worse outcomes.
Реферат
The Covid19 pandemic has led to many publications about its influence on the treatment and evolution of individuals with a substance use disorder, leading to contradictory results. In this study, the adherence and abstinence rates of patients who started treatment in an Addictive Behavior Unit during the pandemic are analyzed, compared with others who attended the previous year and comparing those who were attended in person or by phone. The results indicate that during the Covid19 period, patients had greater adherence to treatment after one month of follow up and when attended to by phone. At 3 and 12 months, greater adherence was maintained, although it was not statistically significant. Regarding abstinence, the small sample size made it difficult to obtain significant differences. The conclusion is that, despite a quantitative decrease in the number of patients beginning drug treatment, in qualitative terms the pandemic led to greater adherence in the short and medium term. Telephone attention can play an important and positive role at this point, complementary to other resources and interventions.
La pandemia por covid19 ha generado muchas publicaciones acerca de su influencia en el tratamiento y evolución de personas con un trastorno por uso de sustancias, con resultados contradictorios, a veces basadas en datos y otras en inferencias indirectas de otros datos. En este trabajo se estudia la adherencia y tasas de abstinencia de pacientes que inician tratamiento en una Unidad de Conductas Adictivas durante la pandemia, respecto a otros que acudieron el año previo y comparando los que hicieron visita presencial o telefónica. Los resultados indicaron mejor adherencia al mes de seguimiento en los pacientes del periodo covid19 y en los que fueron atendidos telefónicamente. A los 3 y 12 meses se mantuvo una mejor adherencia, aunque no significativa estadísticamente. Respecto a la abstinencia, el pequeño tamaño de la muestra dificultó obtener diferencias significativas. Se concluye que la pandemia, aunque ha significado una disminución del número de inicios de tratamientos por consumo de sustancias, también ha repercutido en una mayor adherencia a corto y medio plazo. La atención telefónica puede jugar un papel importante y positivo en este aspecto, complementario a otros recursos e intervenciones.