Editor’s note: EULAR 2020, the annual European congress of rheumatology, which was originally scheduled to be held in Frankfurt, Germany, starting June 3, was moved to a virtual format due to the COVID-19 pandemic.
EULAR 2020 e-CONGRESS—Early data on COVID-19 infection and hospitalization are reassuring regarding the safety of biologic therapy, and patients should generally be kept on the therapies, according to experts at the European e-congress of rheumatology. The assessments come from databases that have been assembled in Europe by researchers working quickly to get a portrait of patients with rheumatic diseases infected by SARS-CoV-2.
Dr. Hyrich mentioned two cases with very different outcomes to illustrate the vexing nature of COVID-19 and the need to identify useful patterns. A 38-year-old woman with lupus nephritis was taking hydroxychloroquine, azathioprine, belimumab and steroids. Once infected with SARS-CoV-2, she had a severe course of pneumonitis, requiring intubation, renal failure and a prolonged intensive care unit stay. The other case was a 45-year-old man with spondyloarthritis and inflammatory bowel disease who was taking adalimumab and budesonide. He had an incidental positive COVID-19 test, but showed no symptoms.
“We need a way to rapidly capture the experience and outcome among patients with rheumatic diseases who acquire this infection,” Dr. Hyrich said. She acknowledged there is a high likelihood of bias, because a lack of community testing means asymptomatic and mild cases will be missed; and the full number of the at-risk population is not known, meaning researchers can’t draw conclusions about incidence or cause and effect of individual medications or diseases.
Study Results
Based on an analysis of data from 600 patients from 40 countries in the Global Alliance database, those on biologic disease-modifying anti-rheumatic drugs (DMARDs) or targeted synthetic DMARDs had a 50% lower chance of hospitalization compared with those not on a DMARD.1
“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.
Of those 19 patients, four—or 21%—died. That translates to 1.2 deaths per 100 patient-years, Dr. Gonzalez said. That percentage of deaths was higher than the 12% who died across all COVID-19 hospital admissions, but was not a statistically significant difference, he said.
Continue Treatment
“It seems reasonable,” Dr. Gonzalez said, “that patients with inflammatory diseases treated with bio DMARDS or targeted synthetic DMARDs continue their treatment during the COVID-19 epidemic.”
Thomas R. Collins is a freelance writer living in South Florida.
Reference
- Gianfrancesco M, Hyrich KL, Al-Adely S, et al. Characteristics associated with hospitalization 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.
