Drugs for Rheumatic Conditions Usually Don’t Worsen COVID-19 Course

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Drugs for Rheumatic Conditions Usually Don’t Worsen COVID-19 Course

When the COVID-19 pandemic began, there were significant concerns that drugs used to treat rheumatic conditions might cause patients to get more severe infections. That doesn’t appear to be the case, however, although researchers caution that glucocorticoid exposure of 10 or more mg/day was associated with a higher risk of hospitalization, with other therapies either appearing protective or having no effect. Here are more details.

HERSTON, AUSTRALIA – In general, patients using drugs to treat rheumatic conditions didn’t appear to have increased odds of hospitalization if they contracted COVID-19.

That’s according to a presentation at the European Congress of Rheumatology that was also published in Annals of the Rheumatic Diseases. University of Queensland-led authors report that glucocorticoid exposure of  10 or more mg/day is associated with a higher odds of hospitalization, while use of an anti-TNF is linked to decreased odds of a serious COVID-19 case in patients with rheumatic disease. The authors of the international study add that neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalization.

https://ard.bmj.com/content/annrheumdis/early/2020/05/29/annrheumdis-2020-217871.full.pdf

Drugs for rheumatic conditions are used to suppress the rogue immune system which attacks its own body, according to background information in the article, but it has been unclear whether the use of immunosuppressants increases the risk of a severe course in case of an infection with the novel coronavirus SARS-CoV-2.

Researchers examined demographic and clinical factors associated with COVID-19 hospitalization status in people with rheumatic disease to help answer that question.

To do that, they used a case series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry from March 24, 2020, to April 20, 2020. Taken into account were patients’ age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection. Included were 600 cases from 40 countries.

Results indicate that nearly half of the cases were hospitalized (277, 46%) and 55 (9%) died. Here were the findings using multivariable adjusted models:

  • Prednisone dose ≥10mg/day was associated with higher odds of hospitalization (OR 2.05, 95% CI 1.06 to 3.96).
  • Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalization (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively).
  • Non-steroidal antiinflammatory drug (NSAID) use was not associated with hospitalization status (OR 0.64, 95% CI 0.39 to 1.06).
  • Tumor necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalization (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed.

"The study shows that most patients with rheumatological conditions recover from COVID-19 - independent of the medication they receive," said John Isaacs, PhD, BSc, MB,  from The University of Newcastle, United Kingdom, Scientific Chair of the EULAR Scientific Committee. "It is necessary, however, to gather more knowledge about the course of an infection with the novel coronavirus in patients with inflammatory rheumatic conditions."

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