Risk and outcome of COVID-19 infection in sarcoidosis patients: results of a self-reporting questionnaire

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Robert P. Baughman
Elyse Lower
Mindy Buchanon
Paola Rottoli
Marjolein Drent
Jacobo Sellares
Michelle Terwiel
Marjon Elfferich
Joel Francesqui
Maria Rita Barriuso Cabrerizo
Nadera Sweiss
Filippo Martone
Marc Judson


COVID-19, sarcoidosis, immunosuppression


Background: It has been suggested that sarcoidosis patients, especially those on immunosuppressive medications, are at increased risk for COVID-19 infection and more severe disease.

Methods: A questionnaire was developed in four languages (English, Dutch, Italian, and Spanish). The questionnaire queried whether patients had been infected with COVID-19 and outcome of the infection. Risk factors for COVID-19 infection were collected.  

Results: A total of 5200 sarcoidosis patients completed the questionnaire with 116 (2.23%) reporting infection and 18 (15.8%) required hospitalization. Increased hazard ratio (HR) for COVID-19 infection were seen for those with a COVID-19 infected roommate (HR=27.44, p<0.0001), health care provider (HR=2.4, p=0.0001), pulmonary sarcoidosis (HR=2.48, p=0.001), neurosarcoidosis (HR=2.02, p<0.01), or rituximab treatment (HR=5.40, p<0.0001). A higher rate of hospitalization was found for those with underlying heart disease (HR=3.19 (1.297-7.855), p<0.02). No other feature including race, other immunosuppressive agent, age, or underlying condition was associated with a significant increased risk for infection or more severe disease.

Conclusion: The overall rate of COVID-19 was 2.23%, suggesting an increased rate of COVID-19 infection. However, when an analysis of the questionnaires of sarcoidosis and non-sarcoidosis patients was performed in one localized area over this time period, the rate of COVID-19 infection was similar in both groups. Sarcoidosis patients who cohabitated with COVID-19 infected individuals, worked in health care, had pulmonary or neurologic sarcoidosis, or were treated with rituximab had an increased risk for COVID-19 infection. No significant increased risk for hospitalization could be identified based on age, race, gender or any specific immunosuppressive treatment. 


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(1) Southern BD. Patients with interstitial lung disease and pulmonary sarcoidosis are at high risk for severe illness related to COVID-19. Cleve Clin J Med 2020;10.
(2) Li J, Huang DQ, Zou B, Yang H, Hui WZ, Rui F et al. Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol 2020;10.
(3) Morgenthau AS, Levin MA, Freeman R, Reich DL, Klang E. Moderate or Severe Impairment in Pulmonary Function is Associated with Mortality in Sarcoidosis Patients Infected with SARS‑CoV‑2. Lung 2020;10-00392.
(4) Conticini E, Bargagli E, Bardelli M, Rana GD, Baldi C, Cameli P et al. COVID-19 pneumonia in a large cohort of patients treated with biological and targeted synthetic antirheumatic drugs. Ann Rheum Dis 2020;annrheumdis-217681.
(5) Minotti C, Tirelli F, Barbieri E, Giaquinto C, Donà D. How is immunosuppressive status affecting children and adults in SARS-CoV-2 infection? A systematic review. J Infect 2020; 81(1):e61-e66.
(6) Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY) 2020; 12(7):6049-6057.
(7) Hu Y, Sun J, Dai Z, Deng H, Li X, Huang Q et al. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Virol 2020; 127:104371. doi: 10.1016/j.jcv.2020.104371. Epub@2020 Apr 14.:104371.
(8) Espinosa OA, Zanetti ADS, Antunes EF, Longhi FG, Matos TA, Battaglini PF. Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis. Rev Inst Med Trop Sao Paulo 2020; 62:e43. doi: 10.1590/S1678-9946202062043. eCollection@2020.:e43-9946202062043.
(9) Sweiss NJ, Korsten P, Syed HJ, Syed A, Baughman RP, Yee AMF et al. When the Game Changes: Guidance to Adjust Sarcoidosis Management During the COVID-19 Pandemic. Chest 2020;(20):10.
(10) Harper LJ, Gerke AK, Wang XF, Ribeiro Neto ML, Baughman RP, Beyer K et al. Income and Other Contributors to Poor Outcomes in U.S. Patients with Sarcoidosis. Am J Respir Crit Care Med 2020; 201(8):955-964.
(11) Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2):377-381.
(12) Çelebi G, Pişkin N, Çelik BA, Altunay Y, Salcı KA, Tüz MA et al. Specific risk factors for SARS-CoV-2 transmission among health care workers in a university hospital. Am J Infect Control 2020;(20):10.
(13) Iannone P, Castellini G, Coclite D, Napoletano A, Fauci AJ, Iacorossi L et al. The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness. PLoS ONE 2020; 15(6):e0234025.
(14) Jayaweera M, Perera H, Gunawardana B, Manatunge J. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. Environ Res 2020; 188:109819. doi: 10.1016/j.envres.2020.109819. Epub@2020 Jun 13.:109819.
(15) Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020; 55(5):2000547-2002020.
(16) Kim H, Hong H, Yoon SH. Diagnostic Performance of CT and Reverse Transcriptase Polymerase Chain Reaction for Coronavirus Disease 2019: A Meta-Analysis. Radiology 2020; 296(3):E145-E155.
(17) Lei H, Xu X, Xiao S, Wu X, Shu Y. Household transmission of COVID-19-a systematic review and meta-analysis. J Infect 2020;(20):10.
(18) Zhao Y, Cui C, Zhang K, Liu J, Xu J, Nisenbaum E et al. COVID19: A Systematic Approach to Early Identification and Healthcare Worker Protection. Front Public Health 2020; 8:205. doi: 10.3389/fpubh.2020.00205. eCollection@2020.:205.
(19) Parrish SC, Lin TK, Sicignano NM, Lazarus AA. Sarcoidosis in the United States Military Health System. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35(3):261-267.
(20) Aksoy S, Harputluoglu H, Kilickap S, Dede DS, Dizdar O, Altundag K et al. Rituximab-related viral infections in lymphoma patients. Leuk Lymphoma 2007; 48(7):1307-1312.
(21) Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis 2020; 94:91-95. doi: 10.1016/j.ijid.2020.03.017. Epub@2020 Mar 12.:91-95.
(22) Haberman R, Axelrad J, Chen A, Castillo R, Yan D, Izmirly P et al. Covid-19 in Immune-Mediated Inflammatory Diseases - Case Series from New York. N Engl J Med 2020; 383(1):85-88.
(23) Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L 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 2020; 79(7):859-866.
(24) Sanchez-Piedra C, Diaz-Torne C, Manero J, Pego-Reigosa JM, Rúa-Figueroa Ã, Gonzalez-Gay MA et al. Clinical features and outcomes of COVID-19 in patients with rheumatic diseases treated with biological and synthetic targeted therapies. Ann Rheum Dis 2020; 79(7):988-990.
(25) Das S, Bhowmick S, Tiwari S, Sen S. An Updated Systematic Review of the Therapeutic Role of Hydroxychloroquine in Coronavirus Disease-19 (COVID-19). Clin Drug Investig 2020; 40(7):591-601.
(26) Syed H, Ascoli C, Linssen CFM, Vogt C, Iden T, Syed A et al. Infection prevention in sarcoidosis: proposal for vaccination and prophylactic therapy. Sarcoidosis Vasc Diffuse Lung Dis 2020; 37(2):87-98.