Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry

Abstract

ObjectiveTo investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA).MethodsWe analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders.ResultsOf 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity.ConclusionsPeople with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.

Antibody responses after documented COVID-19 disease in patients with autoimmune rheumatic disease

“…Secondly, though we had only 50 patients in the cohort with different rheumatological diseases and different drugs, it is the largest cohort to date, to the best of our knowledge, of proven COVID-19 in rheumatic diseases to have their specific protective antibodies tested, and it was done within a pre-fixed narrow time frame of 2 months after testing positive for COVID-19. The previous study includes 13 patients who were tested at different times after COVID-19 infection (intra-quartile range: 60–146 days) [ 8 ].…”

“…The presence of other non-neutralizing antibodies is associated with more severe COVID-19 [ 7 ]. Previously, in a cohort of 13 patients with rheumatic diseases in Boston, USA, neutralizing antibodies were present in 10 (76.9%) [ 8 ].…”

Coronavirus Disease 2019 (COVID-19) and Immune-mediated Rheumatic Diseases. Recommendations of the Association of Rheumatologists of Russia

“…Особое внимание привлечено к вкладу противовоспалительной терапии, поскольку, как уже отмечалось, многие препараты, применяющиеся при ИВРЗ (в первую очередь при РА), «репозиционированы» для лечения COVID-19 [13]. Представляет интерес анализ материалов Врачебного регистра Глобального ревматологического альянса COVID-19 (COVID-19 Global Rheumatology Alliance physician registry) [62], свидетельствующих о том, что инфузии РТМ и прием o n l i n e fi r s t [63]. Сходные данные получены ранее в отношении риска тяжелых инфекцией, не связанных с COVID-19 [117,118].…”

Deutsches Register www.Covid19-Rheuma.de

“…Besonders hervorzuheben war, dass auch die Krankheitsaktivität der ERE als ein unabhängiger Prädiktor für eine Hospitalisierung identifiziert werden konnte [ 8 ]. Dies zeigte sich auch in der Analyse der globalen Registerdaten, bei der eine erhöhte Krankheitsaktivität signifikant assoziiert war mit COVID-19-bedingter Mortalität [ 9 ]. Hierdurch ließ sich die Empfehlung der DGRh, bestätigen, dass eine adäquat immunmodulatorisch therapierte ERE ein geringeres Risiko für eine Hospitalisierung bzw.…”

“…Hierdurch ließ sich die Empfehlung der DGRh, bestätigen, dass eine adäquat immunmodulatorisch therapierte ERE ein geringeres Risiko für eine Hospitalisierung bzw. einen schweren Krankheitsverlauf bei einer SARS-CoV-2-Infektion haben dürfte [ 8 , 9 ]. Eine rasch zunehmende Zahl von Publikationen zu COVID-19 generell und speziell bei Patienten mit ERE, hier insbesondere auch aus den Registern, war für die DGRh dann auch Anlass, die ersten Handlungsempfehlungen nach systematischer Literaturrecherche bereits Mitte 2020 zu aktualisieren [ 10 ].…”