Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry

• Published in: Annals of the rheumatic diseases Vol. 80; no. 9; pp. 1137 - 1146
• Main Authors: Sparks, Jeffrey A, Wallace, Zachary S, Seet, Andrea M, Gianfrancesco, Milena A, Izadi, Zara, Hyrich, Kimme L, Strangfeld, Anja, Gossec, Laure, Carmona, Loreto, Mateus, Elsa F, Lawson-Tovey, Saskia, Trupin, Laura, Rush, Stephanie, Katz, Patricia, Schmajuk, Gabriela, Jacobsohn, Lindsay, Wise, Leanna, Gilbert, Emily L, Duarte-García, Ali, Valenzuela-Almada, Maria O, Pons-Estel, Guillermo J, Isnardi, Carolina A, Berbotto, Guillermo A, Hsu, Tiffany Y -T, D’Silva, Kristin M, Patel, Naomi J, Kearsley-Fleet, Lianne, Schäfer, Martin, Ribeiro, Sandra Lúcia Euzébio, Al Emadi, Samar, Tidblad, Liselotte, Scirè, Carlo Alberto, Raffeiner, Bernd, Thomas, Thierry, Flipo, René-Marc, Avouac, Jérôme, Seror, Raphaèle, Bernardes, Miguel, Cunha, Maria Margarida, Hasseli, Rebecca, Schulze-Koops, Hendrik, Müller-Ladner, Ulf, Specker, Christof, Souza, Viviane Angelina de, Mota, Licia Maria Henrique da, Gomides, Ana Paula Monteiro, Dieudé, Philippe, Nikiphorou, Elena, Kronzer, Vanessa L, Singh, Namrata, Ugarte-Gil, Manuel F, Wallace, Beth, Akpabio, Akpabio, Thomas, Ranjeny, Bhana, Suleman, Costello, Wendy, Grainger, Rebecca, Hausmann, Jonathan S, Liew, Jean W, Sirotich, Emily, Sufka, Paul, Robinson, Philip C, Machado, Pedro M, Yazdany, Jinoos
• Format: Journal Article
• Language: English
• Published: England Elsevier Limited 01.09.2021; BMJ Publishing Group
• Subjects: Aged; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Cancer therapies; Cardiovascular disease; Clinical trials; Comorbidity; Coronaviruses; COVID-19; COVID-19 - complications; Diabetes; Drug dosages; Ethnicity; Female; Humans; Hypertension; Immunotherapy; Interleukin 6; Janus kinase; Kidney diseases; Life Sciences; Male; Middle Aged; Monoclonal antibodies; Oxygen; Patients; Registries; Rheumatic diseases; Rheumatoid Arthritis; Rheumatology; Rituximab; SARS-CoV-2; Severity of Illness Index; Targeted cancer therapy; Tumor necrosis factor; Tumor necrosis factor-TNF; Tumors; United States > US; tumour necrosis factor inhibitors; Covid-19; rheumatoid arthritis; abatacept; rituximab
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/annrheumdis-2021-220418

ObjectiveTo investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA).MethodsWe analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders.ResultsOf 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity.ConclusionsPeople with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.