Use of conventional synthetic and biologic disease-modifying anti-rheumatic drugs in patients with rheumatic diseases contracting COVID-19: a single-center experience

Abstract

To examine whether patients with inflammatory arthritis (IA) treated with conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) and/or biologic (b) DMARDs, could be affected from SARS-CoV-2 infection and to explore the COVID-19 disease course and outcome in this population. This is a prospective observational study. During the period February–December 2020, 443 patients with IA who were followed-up in the outpatient arthritis clinic were investigated. All patients were receiving cs and/or bDMARDs. During follow-up, the clinical, laboratory findings, comorbidities and drug side effects were all recorded and the treatment was adjusted or changed according to clinical manifestations and patient’s needs. There were 251 patients with rheumatoid arthritis (RA), 101 with psoriatic arthritis (PsA) and 91 with ankylosing spondylitis (AS). We identified 32 patients who contracted COVID-19 (17 RA, 8 PsA, 7 AS). All were in remission and all drugs were discontinued. They presented mild COVID-19 symptoms, expressed mainly with systemic manifestations and sore throat, while six presented olfactory dysfunction and gastrointestinal disturbances, and all of them had a favorable disease course. However, three patients were admitted to the hospital, two of them with respiratory symptoms and pneumonia and were treated appropriately with excellent clinical response and outcome. Patients with IA treated with cs and/or bDMARDs have almost the same disease course with the general population when contract COVID-19.

Colchicine Against SARS-CoV-2 Infection: What is the Evidence?

“…However, in the last year biological therapies and colchicine have been used as potential therapeutic agents against the SARS-CoV-2 infection [ 4 , 8 , 9 , 17 ]. Indeed, in patients with ARD who contracted COVID-19 whilst receiving biological therapies (especially cytokine inhibitors), the disease expressed with mild systemic manifestations, less hospitalization, and less severe complications [ 23 – 25 ]. On the other hand, in patients with FMF or gouty arthritis receiving colchicine, the disease manifested without severe respiratory complications and they recovered without additional treatment [ 26 – 28 ].…”

TNF-α Blockers Showed Prophylactic Effects in Preventing COVID-19 in Patients with Rheumatoid Arthritis and Seronegative Spondyloarthropathies: A Case–Control Study

“…The results of previous studies [18][19][20]25] showed the positive effects of anti-TNF drugs on reducing the severity of COVID-19 and hospitalization percentage. Moreover, our results indicated the effect of TNF-a inhibitors in decreasing the incidence of COVID-19.…”

“…For example, it was reported that the severity of COVID19 symptoms and the need for hospitalization were lower in patients with inflammatory bowel disease (IBD) who were receiving anti-TNF treatments [18]. In another study, no correlation between consumption of TNF-a blockers and increased severity of COVID-19 in patients with rheumatic diseases has been observed [19]. Moreover, the results obtained from data of the COVID-19 Global Rheumatology Alliance registry indicated that anti-TNF decreased the chance of hospitalization caused by COVID-19 in patients suffering from rheumatic disease [20] and TNF inhibitors are not associated with death caused by COVID-19 [21].…”

Systematic review with meta‐analysis: COVID‐19 outcomes in patients receiving anti‐TNF treatments

“…Based on the COVID‐19 status of the studied populations, we analysed studies that reported the association between anti‐TNF treatment and the risk for hospitalisation, ICU admission and death due to COVID‐19 in patients with COVID‐19 17,67,76‐85,68,86‐94,69‐75 and in patients who receive anti‐TNF treatment without having contracted SARS‐CoV‐2, 95‐101 separately.…”