Use of biologics by patients with immune-related inflammatory disease and SARS-CoV-2 infection does not appear to be associated with worse COVID-19 outcomes.

In Correspondence to the editor of the NEJM, a prospective cases series comprised 86 patients with underlying rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, inflammatory bowel disease, or related conditions and confirmed or highly suspected COVID-19.

The New York series showed a minority of patients (16%) warranted hospitalisation for severe COVID-19 disease. Most (79%) were subsequently discharged by the end of the study period and there had been one death.

An analysis of baseline medication use showed 50% of the patients who were hospitalised for COVID-19 were receiving biologics or JAK inhibitors for their underlying condition compared to 76% of ambulatory patients.

However more hospitalised than ambulatory patients were using other medications for their immune-related inflammatory disease – 29% v 6% for oral glucocorticoids, 21% v 7% for hydroxychloroquine, and 43% v 15% for methotrexate.

The authors said there was clearly an urgent need for more knowledge on the effects of anticytokine and other immunosuppressive therapies in COVID-19 and for guidance on the care of patients with immune-mediated inflammatory disease during the pandemic.

“Although our analysis was limited in sample size, our data reveal an incidence of hospitalization among patients with immune-mediated inflammatory disease that was consistent with that among patients with COVID-19 in the general population in New York City reported by the New York City Department of Health and Mental Hygiene (35,746 of 134,874 patients [26%]).”

“These findings suggest that the baseline use of biologics is not associated with worse COVID-19 outcomes.”