Does the Impact of COVID-19 on Patients With Systemic Sclerosis Change Over Time?

OBJECTIVE: Outcome of COVID-19 patients improved over the pandemic, including patients with systemic rheumatic diseases. However, data on systemic sclerosis (SSc) patients are lacking. This study aimed to assess the outcome of SSc patients with COVID-19 over several waves. METHODS: SSc patients with COVID-19 registered in the European Scleroderma Trials and Research group (EUSTAR) were collected between April 2020 and April 2021. Patients were assigned to wave 1 to 3 depending on date of COVID-19. Primary endpoints were death, intensive care unit stay or ventilatory support (severe outcome). Subgroup analyses of patients who were hospitalized or died were conducted. General and SSc-specific characteristics and treatment were compared over the waves. Descriptive statistics and multivariate logistic regression were applied. RESULTS: 333 patients were included; 57 patients (17%) had a severe outcome, and 30 patients died (9%). Compared to wave 1, significantly fewer SSc patients suffered from severe COVID-19 in wave 2 and 3 (28.2% vs. 9.8% and 12.7%; p<0.001), less patients required hospitalization (46.7% vs. 19.6% and 25.5%; p<0.001) or ventilatory support (24.0% vs. 8.7% and 10.9%; p=0.001) and fewer patients died (15.7% vs. 5.0% and 7.5%; p=0.011). Patients were significantly younger, more often male, had less frequently arterial hypertension and less SSc cardiac involvement over wave 1 to 3. Patients received significantly less medium to high dose corticosteroids as SSc treatment. CONCLUSIONS: Outcome of SSc patients with COVID-19 improved significantly over time, due to intrinsic and extrinsic factors.