Majority of Patients With Rheumatic Conditions Recover From COVID-19 Regardless of Rheumatic Disease Therapy

June 5, 2020

Drugs used to treat rheumatic conditions suppress the rogue immune system, but it has been unclear whether patients using immunosuppressants have an increased risk of a more severe course if they are infected with the coronavirus disease 2019 (COVID-19).

Drugs used to treat rheumatic conditions suppress the rogue immune system, but it has been unclear whether patients using immunosuppressants have an increased risk of a more severe course if they are infected with the coronavirus disease 2019 (COVID-19).

New research presented at the European Congress of Rheumatology of the European League Against Rheumatism and published online in the Annals of Rheumatic Diseases, has now shown that a moderate to high dose of glucocorticoid can increase the odds of hospitalization, while use of a tumor necrosis factor inhibitor (anti-TNF) was associated with decreased odds of hospitalization.

The researchers analyzed 600 cases from 40 countries submitted to the COVID-19 Global Rheumatology Alliance physician registry, a registry of people with rheumatic diseases who were diagnosed with COVID-19.

“In general, immunosuppression and the presence of comorbidities are associated with an increased risk of serious infection in people with rheumatic diseases therefore, people with rheumatic disease may be at higher risk for a more severe course with COVID-19, including hospitalisation, complications and death,” the authors explained.

They evaluated the patients’ age, sex, smoking status, rheumatic disease diagnosis, comorbidities, and medication against rheumatic conditions taken immediately prior to COVID-19 infection.

Of the 600 cases, 277 (46%) were hospitalized and 55 (9%) were deceased. The authors did note that one limitation of the study is that more severe cases are more likely to be captured in the registry, and as a result, the rate of hospitalization/death is likely artificially increased in the group of reported patients.

“Therefore, the data cannot be used to comment on the incidence of COVID-19 in this patient population or its severity,” they wrote.

The researchers found that the use of conventional disease-modifying antirheumatic drugs alone or in combination with biologics, as well as the intake of nonsteroidal anti-inflammatory drugs, was not associated with hospitalization. Anti-TNFs were associated with a reduced likelihood of hospitalization, and there was no association with the use of anti-malarial drugs, such as hydroxychloroquine.

However, treatment with ≥10 mg/day of prednisone, a glucocorticoid, was associated with a higher probability of hospitalization. This finding does align with previous research that showed higher doses of glucocorticoids were associated with an increased risk of infection.

"The study shows that most patients with rheumatological conditions recover from COVID-19—independent of the medication they receive," John Isaacs, MBBS, PhD, The University of Newcastle, United Kingdom, Scientific Chair of the EULAR Scientific Committee, said in a statement. "It is necessary, however, to gather more knowledge about the course of an infection with the novel coronavirus in patients with inflammatory rheumatic conditions."

Reference

Gianfrancesco M, Hyrich KL, Al-Adely S, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry [published online May 29, 2020]. Ann Rheum Dis. doi:10.1136/ annrheumdis-2020-217871