Rheumatoid arthritis

Italian experience shows no increased risk with DMARDs in COVID-19 disease

Rheumatologists in an Italian hotspot for COVID-19 says they are reassured by observations that none of their patients treated with bDMARDs or tsDMARDs developed severe respiratory complications after being infected by the virus.

Writing in the Annals of Rheumatic Diseases, clinicians from a rheumatology clinic in Pavia near Milan say that eight of their 320 patients taking DMARDs had confirmed or suspected COVID-19 infection but none of them experienced serious adverse outcomes.

They said their review of the impact of COVID-19 disease in 320 patients with RA or spondyloarthritis suggests there is no need to withdraw immunotherapy for fear of increased risk of respiratory or life-threatening complications.

Their observations come from a cohort of patients with RA or SpA seen over two months at the clinic, of whom 68% were female and the average age was 55. All patients continued taking their medications for arthritis, which included TNF inhibitors (52%), other bDMARDs (40%) and tsDMARDs (8%). Three of the patients were on concomitant hydroxychloroquine prior to being infected and four were taking low dose glucocorticoids.

All patients with symptoms of COVID-19 infection temporarily withdrew the bDMARD or tsDMARD during the infection, but there were no significant relapses of the rheumatic disease.

None of the patients with confirmed or suspected COVID-19 infection developed severe respiratory complications or died. Only one patient required admission to hospital and low-flow oxygen supplementation for a few days.

Likewise there were no serious adverse outcomes for five other patients who were close contacts of people with COVID-19 and may have been asymptomatic.

And conversely, none of the 700 patients admitted to the hospital’s ICU for severe complications of COVID-19 disease were receiving bDMARDs or tsDMARDs, they noted

The doctors from the Rheumatology Department of the IRCCS Fondazione Policlinico San Matteo, said their observational findings did not allow conclusions to be drawn about the incidence rate of COVID-19 infection in patients with rheumatic diseases, nor on the overall outcome of immunocompromised patients affected by COVID-19.

“However, our preliminary experience shows that patients with chronic arthritis treated with bDMARDs or tsDMARDs do not seem to be at increased risk of respiratory or life-threatening complications from SARS-CoV-2 compared with the general population,” they commented.

They say the findings that immunosuppressive treatment is not associated with increased risk are not surprising given that the severe complications of COVID-19 are related to a cytokine inflammatory response. They also agree with previous observations with SARS that immunosuppressive treatment was not associated with increased risk.

“These data can support rheumatologists for the management and counselling of their patients, avoiding the unjustifiable preventive withdrawal of DMARDs, which could lead to an increased risk of relapses and morbidity from the chronic rheumatological condition,” they concluded.

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