Influence of biologic and conventional disease-modifying antirheumatic drugs on COVID-19 incidence among rheumatic patients during the first and second wave of the pandemic in Iran

Abstract

Introduction: During the SARS-CoV-2 virus pandemic, immunosuppressive agents in treating chronic disease have become a concern, and rheumatic patients are not an exception. The controversies about the deteriorating effects of such medications led this study to evaluate the influence of biologic and conventional disease-modifying antirheumatic drugs (DMARDs) on the incidence of COVID-19 infection in rheumatic patients. Material and methods: In the present cohort-analytical study, 512 patients with rheumatic diseases were enrolled during the COVID-19 pandemic (2020COVID-19 pandemic ( -2021. The incidence of COVID-19 infection was diagnosed according to the definition of the Iranian Ministry of Health. The frequency of COVID-19 infection in patients treated with biological and conventional DMARDs and glucocorticosteroids were compared. Results: Among 512 rheumatic patients, 19.9% were definitely infected with COVID-19, and 23.3% of infected patients were hospitalized. Only one patient with vasculitis died during the two outbreaks. Our study showed that adding biologic DMARDs to conventional DMARDs did not increase the risk of COVID-19 infection. However, unlike biologic DMARDs, in conventional DMARDs, methotrexate increased, and hydroxychloroquine decreased COVID-19 infection. Regression analysis showed that prednisolone at a dosage higher than 10 mg/day increased the risk of COVID-19 infection 5-fold; hydroxychloroquine had a protective impact and reduced the risk of infection by 40%. Conclusions: Biologic DMARDs and the type of selected rheumatic diseases in our study did not influence the susceptibility to COVID-19 infection. Prednisolone raised the coronavirus infection, and hydroxychloroquine played a protective role in the current study. Most of our patients showed good adherence to the health protocols. Further studies after worldwide vaccination are now required to reevaluate the influence of rheumatic diseases and DMARDs on COVID-19 infection.

Effect of traditional therapeutics on prevalence and clinical outcomes of coronavirus disease 2019 in Chinese patients with autoimmune diseases

“…CNI, MMF, CTX, MTX were also commonly used for the management of rheumatic disease. In our study, there was no association between COVID-19 infection with those drugs, which was inconsistent with previous studies in Iran that MTX and CTX significantly increased but HCQ decreased the risk of COVID-19 infection in patients with rheumatic disease [ 27 ]. This discrepancy may due to the number, race and ethnicity of patients enrolled.…”

Systemic Lupus Erythematosus and COVID-19

“…In adjusted models, SLE individuals on RTX experienced worst outcomes regarding hospitalization and ventilation compared to reference group (SLE patients only on antimalarials) (OR 1.69). Similar results were obtained for mechanical ventilation and death [ 80 •, 110 – 112 , 113 •]. This increased risk for a more severe COVID-19 course has been confirmed also in various cohorts of patients with other systemic autoimmune diseases treated with RTX, including systemic sclerosis and multiple sclerosis, owing to the blunted humoral immune response conferred by B-cell depleting action [ 88 •, 113 •, 114 – 116 ], with this risk being higher shortly after RTX infusion.…”