For patients with rheumatic disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, prednisone use of ≥10 mg/day may be associated with a higher odds of hospitalization whereas tumor necrosis factor (anti-TNF) inhibitors may be linked with a decreased risk of hospitalization, according to a study published in Annals of Rheumatic Disease.
Since the outbreak of the novel coronavirus (COVID-19) pandemic, clinicians have voiced concerns that the use of immunosuppressant drugs may place patients at higher risk of poor outcomes. The findings from this study should reassure patients who are currently taking biologic therapies, nonsteroidal anti-inflammatory drugs (NSAIDs), or hydroxychloroquine that they are not at greater risk of hospitalization from COVID-19, reported the authors.
Case series of individuals with rheumatic disease and COVID-19 were obtained from the COVID-19 Global Rheumatology Alliance (C19-GRA) registry. Physicians indicated whether the diagnosis of COVID-19 was based on RT-PCR, antibody, and/or metagenomic testing; CT scan; laboratory assay; or a presumptive diagnosis based on symptoms only.
The report included the approximate number of days from symptom onset to symptom resolution or death. Case information including age, sex, smoking status, rheumatic disease diagnosis, disease activity, and comorbidities was collected. The primary outcome of interest was hospitalization for COVID-19. As of April 20, 2020, a total of 604 cases were entered in the registry; hospitalization status was unknown for 4 cases and these were excluded from analysis.
Medication use in participants prior to COVID-19 onset were categorized as: conventional disease-modifying antirheumatic drugs (DMARDs); biologic DMARDs (bDMARDs); anti-TNF inhibitors, and targeted synthetic DMARDs (tsDMARDs), specifically Janus kinase (JAK) inhibitors.
The majority of cases in the registry were from North America and Europe and were women. The most common rheumatic diseases were rheumatoid arthritis (RA; 38%), followed by systemic lupus erythematosus (SLE; 14%) and psoriatic arthritis (12%). The most common comorbidities reported were hypertension (33%), lung disease (21%), diabetes, (12%), cardiovascular disease, (11%), and chronic renal insufficiency/end-stage renal disease (7%). Nearly half of the cases in the registry were hospitalized (46%) and 9% died.
Diagnosis of COVID-19 predominantly occurred through RT-PCR testing (73%). The median number of days from COVID-19 symptom onset to resolution or death was 13. Most hospitalized patients were >65 years of age (43%) compared with 16% of non-hospitalized cases. Patients hospitalized with COVID-19 had more comorbidities than non-hospitalized patients, but no association was found between disease activity and hospitalization status.
NSAID use was reported less frequently among hospitalized patients compared with nonhospitalized patients (16% vs 25%, respectively), whereas a higher proportion of patients receiving high doses of glucocorticoids were hospitalized compared with those not hospitalized (16% vs 7% for doses ≥10 mg/day). The researchers found no significant difference in hospitalization status by sex, antimalarial therapy, or reported days from symptom onset to symptom resolution or death.
Treatment with bDMARD or tsDMARD monotherapy prior to COVID-19 diagnosis was significantly associated with a lower odds of hospitalization compared with no DMARD therapy. However, glucocorticoid therapy at prednisone-equivalent doses ≥10 mg/day was linked to a higher odds of hospitalization compared with no therapy. Anti-TNF inhibitor use was associated with a reduced odds of hospitalization while no association with antimalarial use was found.
“At the time of this report, the C19-GRA databases remain open for further case reports,” stated the authors. “With additional cases, we will be able to examine more detailed outcomes associated with specific rheumatic diseases and COVID-19 treatments, as well as the outcomes of COVID-19 in people with rheumatic diseases.”
Gianfresco M, Hyrich KL, Al-Adely S, et al; COVID-19 Global Rheumatology Alliance. Characteristics associated with hospitalization 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