Most rheumatology patients recover from COVID-19, regardless of medication

Most rheumatology patients who contract COVID-19 recover from the virus regardless of which medication they take, new data from the COVID-19 global rheumatology alliance registry suggests.

Presented at the EULAR 2020 virtual congress and published in the Annals of the Rheumatic Diseases, the analysis of 600 COVID-19 patients from 40 countries found that nearly half of the cases were hospitalised (n=277, 46%) and 55 (9%) died. 

The  use of conventional disease-modifying anti-rheumatic drugs alone or in combination with biologics or JAK inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively) patients taking TNF inhibitors were less likely to be hospitalised for COVID-19 (OR 0.40, 95% CI 0.19 to 0.81), the analysis showed.

“Although we caution against causal inference regarding drug effects given significant potential for residual confounding in our study, we also note that there is biological plausibility for the potential benefit of biologic medications in treating COVID19, as evidenced by those with more severe disease having higher levels of cytokines, including IL-6 and TNF,” the international team of researchers noted.

No association was seen between prior NSAID use or antimalarials and hospitalisation for COVID-19, glucocorticoid therapy at prednisone-equivalent doses of  ≥10mg/ day was associated with a higher odds of hospitalisation compared with no glucocorticoid therapy (OR=2.05, 95%CI 1.06 to 3.96; p=0.03). 

The authors  noted that this was in line with findings from previous studies showing an increased risk of infection with higher dose of glucocorticoids.

Presenting the findings at the EULAR virtual congress, Dr Pedro Machado, co-senior author of the analysis said:  “There is an urgent need to understand the outcome of patients who have been infected with SARS-CoV-2 while at the same time receiving steroids, synthetic or biological disease-modifying anti-rheumatic drugs and nonsteroidal anti-inflammatory drugs,”

“This [data] will support rheumatologists and other health care professionals, such as specialist nurses, in advising their patients and improving their care,” he added.

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