Initial use of drugs associated with the severity of COVID-19 in people with rheumatic diseases


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Due to sample size limitations, previous studies on the use of DMARD and the results of COVID-19 have combined several different rheumatic diseases and medications and investigated a single outcome, e.g., the risk of hospitalization. EULAR has provided financial support for a global project that collects information on SARS-CoV-2 infection in people with rheumatic diseases. The physician-reported record of COVID-19 Global Rheumatology Alliance was released in March 2020 to collect data on adults with rheumatic disease and confirmed or suspected COVID-19.

This analysis by Jeffrey Sparks, Zachary Wallace, and colleagues sought to investigate the associations between baseline use of biological or targeted synthetic DMARDs with a range of poor COVID-19 outcomes specifically in people with rheumatoid arthritis (RA). The treatments included were abatacept, , JAK inhibitors (JAKi), interleukin-6 inhibitors (IL-6i), orthumornecrosis factor (TNFi) inhibitors. The results were scored on a scale of one to four for the severity of COVID-19: 1) no hospitalization, 2) hospitalization without oxygen, 3) hospitalization with oxygen or ventilation, or 4) death. The authors used an analysis to compare each class of drugs with TNF.

Of the 1,673 people with RA who took b / tsDMARD when they developed COVID-19, 498 (34.3%) were hospitalized and 112 (6.7%) died. Rituximab users were more likely than TNFi users (ILD; 11.6% versus 1.7%) and a history of cancer (7.1% versus 2.0%); JAKi users were more prone to the obese than TNFi users (17.3% vs. 9.0%). After coincidentally, the authors found that rituximab was strongly associated with higher probabilities of having a worse COVID-19 outcome compared to TNFi. Among rituximab users, 42 (18.8%) died compared to 27 (3.3%) TNFi users. JAKi use was also associated with higher probabilities of having a worse COVID-19 severity. People taking abatacept or IL-6 do not have worse COVID-19 severity compared to TNFi. Overall, the results were similar in the sensitivity analysis and after excluding cancer or ILD.

Since the summary was submitted, Sparks adds that the database has been updated, so the numbers have changed and the sample size is larger. The main conclusions are consistent with the initial presentation.

Similar results were found for rituximab in the French RMD cohort. Avouac and colleagues reported the findings on behalf of a consortium of collaborators, including FAI2R, SFR, SNFMI, SOFREMIP, CRI and IMIDIATE. Of 1,090 people included with —Mainly RA-137 developed severe COVID-19 disease (12.6%). After adjusting for possible confounding factors, it was confirmed that severe disease was more common in patients receiving rituximab. People who developed COVID-19 severely received rituximab infusion more recently compared to people with mild to moderate infection.

In this cohort, 89 people died, an overall mortality rate of 8.2%. The mortality rate was numerically higher in people receiving rituximab (20.6%) compared with those not (7.4%) and in the subgroup of untreated patients with diseases eligible for rituximab treatment (9, 9%). However, after adjusting for factors, death did not increase significantly in people treated with rituximab, although the length of hospital stay was significantly longer in people treated with rituximab in comparison with the two untreated groups.

The results obtained so far from these records of people with RA and COVID-19 show that baseline use of rituximab or JAK is associated with a worse severity of COVID-19 compared to TNFi use. The high likelihood of poor COVID-19 outcomes in people taking rituximab highlights the urgent need for strategies to limit their risk, such as the optimal timing of vaccination. He finding that JAKi is associated with poor COVID-19 outcomes is new and needs to be replicated in other studies.

Spread of SARS-CoV-2 infection much greater than that captured with the diagnosis of swab

More information:
Sparks J, et al. Associations of baseline use of synthetic or severely targeted synthetic DMARDs COVID-19 in rheumatoid arthritis: results of the Global Alliance of Rheumatology COVID-19. Presented at EULAR 2021; summary OP0006.

Avouac J, et al. RITUXIMAB: data from the French cohort RMD COVID-19. Presented at EULAR 2021; summary OP0284.

Provided by the European Alliance of Associations for Rheumatology

Citation: Use of Basal Drugs Associated with the Severity of COVID-19 in People with Rheumatic Diseases (2021, June 18) Retrieved June 19, 2021 at -covid-severity-people. html

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