Incidence of COVID‐19 in Patients With Rheumatic Diseases Treated With Targeted Immunosuppressive Drugs: What Can We Learn From Observational Data?

Abstract

Objective. To describe the incidence and severity of coronavirus disease 2019 (COVID-19) in patients with rheumatic diseases treated with targeted synthetic or biologic disease-modifying antirheumatic drugs (DMARDs) compared with that in the general population living in the same Italian region. Methods. Patients followed up at 2 rheumatology referral centers in Lombardy from February 25, 2020 to April 10, 2020 were invited to participate in a survey designed to identify patients who had confirmed COVID-19, close contact with others with confirmed COVID-19, or symptoms of the infection, and to detect changes in work, behavior, and disease management made in an attempt to prevent infection. The incidence of COVID-19 in the Lombardy population was obtained from the National Institute of Statistics. COVID-19 cases were confirmed by nasopharyngeal swab. Results. The survey was given to 955 patients (531 patients with rheumatoid arthritis, 203 patients with psoriatic arthritis, 181 patients with spondyloarthritis, and 40 patients with connective tissue diseases, vasculitides, or autoinflammatory diseases). These patients had a mean age of 53.7 years, and 67.4% were women. The rate of response to the survey was 98.05%, and the incidence of confirmed COVID-19 cases was consistent with that in the general population (0.62% versus 0.66%; P = 0.92). None of the patients had severe complications or required intensive care treatment, and all of the patients who tested positive for COVID-19 temporarily discontinued ongoing targeted synthetic drug or biologic DMARD therapy. Almost all patients took precautions to prevent the COVID-19 infection (90.6%), and almost all continued treatment with targeted synthetic drugs or biologic DMARDs (93.2%). Disease activity remained stable in 89.5% of patients. Conclusion. Our results reflected the attitude of patients with rheumatic diseases regarding the prevention of the infection while maintaining their long-term treatment regimens. The incidence and severity of COVID-19 in patients treated with targeted synthetic drugs or biologic DMARDs was not significantly different from that in the general population in the same region.

Rheumatologists in the COVID-19 era: will there be a new role for the rheumatologist in the care of rheumatic patients?

“…Drug shortages and altered patterns of health care have been concerning since the early days of this pandemic [16]. Several reports point to the fact that prevalence and severity of COVID-19 seem not to be higher in rheumatic patients, even those under treatment with immunosuppressants, biologics, and small molecules, than those found in the general population [17][18][19][20]. This could be different for some conditions.…”

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

“…The effect of gender has not been specifically explored in rheumatic diseases compared with the general population. [103][104][105][106] The clinical features of COVID-19 are similar in patients with RD. There is a higher risk of intensive care unit (ICU) admission and respiratory failure in patients with RD who develop COVID-19 compared with controls.…”

COVID-19 Pandemic in Women–Rheumatologist’s Perspective

“…This could also contribute to the low incidence in this population. 10 A study from Spain reported a 1.32-fold higher risk of PCR positive COVID-19 requiring hospital admission in chronic inflammatory diseases compared with general population. The risk was however variable, depending on the disease and treatment.…”

“…The incidence of COVID-19 in RD was found to be similar to the general population in the same region in two studies from Italy. 10,11 Patient with RD exerted due diligence when it came to preventive measures. This could also contribute to the low incidence in this population.…”

“…12 The severity of COVID-19 in RD seems to be similar to the general population. 10 A global rheumatology alliance that included 600 patients (70% female) of RD from multiple centers found a mortality of 9% in a patients with RD and COVID-19. The most common RD was rheumatoid arthritis (RA).…”