Does the impact of COVID-19 on patients with systemic sclerosis change over time?

Objective:Outcome of COVID-19 patients improved over the pandemic, i ncludi ngpatients with systemic rheumatic diseases. However, data on systemic sclerosis (SSc)patients are lacking. Th is study aimed to assess the outcome of SSc patients withCOV ID-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 C OV ID-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. Generaland 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 suffere d 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 (2 4.0% 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.