Mycophenolate mofetil associates with COVID-19 hospitalization in patients with systemic lupus erythematosus: a nationwide population-based study from China.

INTRODUCTION/

OBJECTIVES

To evaluate the impact of BA.5.2/BF.7 infections on the severity of systemic lupus erythematosus (SLE) and to identify associated risk factors.

METHODS

A cross-sectional study was conducted from January 6 to February 19, 2023. The study population included SLE patients and healthy controls infected with the BA.5.2/BF.7 variants. Odds ratios (ORs), risk differences (RDs), and their corresponding 95% confidence intervals (CIs) were calculated to assess the effects of infection on SLE severity and to explore related risk factors.

RESULTS

A total of 1,013 SLE patients and 2,125 healthy controls who were infected with BA.5.3/BF.7 were enrolled in the study. After adjusting for age, sex, comorbidities, and vaccination status, SLE was significantly associated with an increased risk of COVID-19 hospitalization (adjusted OR [aOR] 6.13, 95% confidence interval [CI] 3.06 to 12.27, p < 0.001). Among SLE patients, COVID-19 infection was associated with an increased risk of rash (risk difference [RD] 4.0%, 95% CI 1.5 to 6.6; p = 0.002), alopecia (RD 4.2%, 95% CI 0.9 to 7.6; p = 0.016), and mucosal ulcers (RD 3.3%, 95% CI 0.8 to 5.7; p = 0.012). Among SLE patients, the use of mycophenolate mofetil (MMF) was significantly associated with an increased risk of COVID-19 hospitalization (aOR 1.99, 95% CI 1.06 to 3.74; p = 0.033).

CONCLUSIONS

These findings highlight the importance of a nuanced approach in managing SLE patients with COVID-19. Key Points • The COVID-19 pandemic spread widely across China. However, the impact of systemic lupus erythematosus (SLE) medications on COVID-19-related hospitalization remains unclear. • Our study found that treatment with mycophenolate mofetil in SLE patients was associated with a higher risk of hospitalization for COVID-19. • These findings should alert policymakers and clinicians to the need for a more nuanced and cautious approach when managing SLE patients infected with the Omicron BA.5.2 or BF.7 subvariants.