Biologic Treatment Recommendations for Rheumatic Disease Patients Who Contract COVID-19

“No definite conclusions regarding risks of COVID-19 associated with biologics were possible; however, we did not see an increased use of biologics among those patients who had been hospitalized,” Dr. Hyrich said. “This suggests that most individuals with rheumatoid diseases who are receiving immunosuppressive therapies recover from COVID-19. And hopefully even these early data should provide some reassurance to patients.”

Those taking more than 10 mg of glucocorticoids per day had double the risk of hospitalization compared with those not taking glucocorticoids, Dr. Hyrich said.

Compared with the average rheumatoid arthritis patient, patients who were older than 65—regardless of their disease type—had 2.6 times the risk of being hospitalized. Hypertension and cardiovascular disease, lung disease, diabetes and chronic renal insufficiency also carried a risk that was double or triple, she said.

Dr. Anne Regierer

These findings dovetailed with some of the findings from the COVID-19-IRD (inflammatory rheumatic diseases) registry in Germany. In an analysis of 192 patients with COVID-19, someone older than 65 had five times the risk of being hospitalized, said Anne Regierer, MD, a physician and researcher at the German Rheumatism Research Centre, Berlin.

Taking glucocorticoids conferred 2.6 times the risk, and cardiovascular disease conferred twice the risk. Being female, being in remission with the inflammatory disease and being on a non-steroidal anti-inflammatory drug may be associated with a lower risk of hospitalization, researchers found.

“As has been described for COVID-19 in general, also in IRD, male gender may be associated with a more severe course of the infection,” Dr. Regierer said, “and risk factors for SARS-CoV-2 infection-dependent hospitalization in IRD patients include old age, cardiovascular comorbidities, and prior and/or current treatment with glucocorticoids.”

She issued a caveat regarding steroids, saying “there’s a reason why patients get glucocorticoids.”

“There should be no advice to stop glucocorticoids at this point,” she said. “The [inflammatory rheumatic disease] which is not well treated is a much bigger fear for the patient.”

In an analysis of more than 1,600 patients on biologic DMARDs or targeted synthetic DMARDs and more than 4,000 COVID-19 hospitalizations, researchers in Spain found the number of patients on biologic DMARDs or targeted synthetic DMARDs who needed to be admitted to the hospital for a COVID-19 infection was low, said Carlos M Gonzalez, MD, a physician and researcher at Gregorio Marañón University Hospital, Madrid. Of the 1,668 patients tracked, just 19—or 1.1%—were hospitalized. That translates to 5.7 events for every 100 patient-years.