Antimalarial use was not significantly associated with the likelihood of hospitalization in adjusted analyses. However, biologic/targeted synthetic DMARD monotherapy reduced the odds of hospitalization in the primary multi-variable analysis. This association was largely driven by anti-TNF therapies. Dr. Robinson says the data do suggest some rheumatic drugs may provide protection during the pandemic, but it is not known whether the findings can be extrapolated to non-rheumatology patients.
These results were similar to those previously found by the WARCOV study.3 In The New England Journal of Medicine report on this study, Haberman et al. described a prospective case series involving patients with known immune-mediated inflammatory disease who were receiving anti-cytokine biologics, other immunomodulatory therapies or both when confirmed or highly suspected symptomatic COVID-19 developed, comparing patients for whom hospitalization was warranted with those for whom it was not. Established patients at New York University Langone Health in New York City who had immune-mediated inflammatory disease were assessed during the period from March 3 through April 3, 2020 (average follow-up, 16 days from symptom onset). The analysis was limited in sample size, but these data suggest the baseline use of biologics is not associated with worse COVID-19 outcomes.
Dr. Robinson and colleagues continue to analyze data from the COVID-19 Global Rheumatology Alliance registry and are in the process of preparing a report on 2,800 cases. This and future efforts will help rheumatologists understand how best to manage rheumatic disease in the era of COVID-19. In the meantime, the ACR has released guidance documents for the treatment of adult and pediatric rheumatic disease patients in the era of COVID-19 that will be updated as the data warrant.
Lara C. Pullen, PhD, is a medical writer based in the Chicago area.
References
- Gianfrancesco M, Hyrich KL, Al-Adely S, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: Data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020 Jul;79(7):859–866.
- COVID-19 Global Rheumatology Alliance. https://rheum-covid.org.
- Haberman R, Axelrad J, Chen A, et al. Covid-19 in immune-mediated inflammatory diseases—case series from New York. N Engl J Med. 2020 Apr 29;NEJMc2009567.
Updated July 7, 2020, to clarify the reference to the WARCOV study.
