Prevalence of COVID infections in a population of rheumatic patients from Lombardy and Marche treated with biological drugs or small molecules: A multicentre retrospective study

Abstract

Objective The COVID-19 pandemic has raised questions about the management of systemic immunosuppressive treatments for rheumatic conditions. It is well known that rheumatic patients are at risk of developing infections because of their immunocompromised state. Moreover, drugs such as hydroxychloroquine or tocilizumab that are widely used to treat rheumatic diseases are now being used to treat COVID-19. The aim of this multicentre retrospective study of rheumatic patients in the Italian regions of Lombardy and Marche was to determine whether patients receiving biological or small molecules treatment are more susceptible to the development of COVID-19 than the general population. Methods The local registry data of 10,260 rheumatic patients being treated with bDMARDs or small molecules were evaluated from 15 March to 23 April 2020. The final analysis was based on the registry data relating to 7.204, telephone contacts and/or outpatient visits. Results Forty-seven of the 7.204 patients were diagnosed with COVID-19, seven of whom died; the patients who had symptoms resembling those of COVID-19 but had negative swabs were considered negative for the disease. The overall infection rate was 0.65, and the crude case fatality risk (CFR) in the patients with COVID-19 was 14.9%. There was no difference in the mortality rate among the patients receiving the different individual biological drugs or small molecules. Conclusions Our findings suggest that the susceptibility of rheumatic patients to COVID-19 is the same as that of the general population, but confirm that age, disease duration, and the number of co-morbidities are associated with an increased risk of a severe form of the disease. It seems that immunosuppressants drugs do not effectively represent a risk factor for COVID- 19.

Clinical management of patients with rheumatoid arthritis during the COVID-19 pandemic

“…However, data from the COVID-19 Global Rheumatology Alliance (C19-GRA) Global Registry showed that, on 28 December 2020, the commonest rheumatic disease in which COVID-19 cases were documented was RA (1540 patients out of 3939) [15]. The same perception arises from other studies where the higher percentage of rheumatic patients in which COVID-19 has been documented have a diagnosis of RA [12,13,[16][17][18]. Incidentally, rheumatoid arthritis is one of the most common diseases among rheumatology outpatients so it is not known if the prevalence of RA patients among COVID-19 cases is due to an increased risk of infection or just a higher proportion among study population.…”

“…), while direct data on rheumatoid arthritis patients are lacking. According to these studies, the incidence of COVID-19 in rheumatic cohorts seems to be similar to the general population [12][13][14].…”

Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study

“…Some studies found higher odds of respiratory failure requiring mechanical ventilation in patients with rheumatic and musculoskeletal diseases than in the general population, 2 , 3 and two times higher odds of hospitalisation in patients with rheumatic and musculoskeletal diseases on prednisone doses above 10 mg daily than those not on prednisone, 4 whereas other studies have not shown higher incidence or severity of COVID-19 in patients with rheumatic and musculoskeletal diseases than in the general population. 5 , 6 …”

COVID-19 and rheumatology: A year later

“…Большая часть исследований, посвященных этому вопросу, была выполнена в европейских регионах с высокой распространенностью COVID-19. В частности, итальянские исследователи проанализировали данные двух локальных регистров, включавших более 7000 больных ИВРЗ, проживавших в Ломбардии и Марке -регионах, наиболее пострадавших от пандемии [3]. Частота верифицированных случаев COVID-19 среди указанных пациентов составила 0,65% и практически совпадала с таковой в популяции Ломбардии (0,66%).…”