Meds modify COVID-19 trajectory

3 minute read

The largest study to date for patients with rheumatic disease and COVID-19 shows which medications increase the risk of hospitalisation.

Rheumatologists across the globe have joined forces to answer the question that has been on all our minds: do immunosuppressive drugs make COVID-19 outcomes worse?

There has been a concern that treatments for rheumatic disease – or rheumatic disease itself – might put patients at greater risk during the pandemic.

The largest dataset to date has brought together the EULAR and Global Rheumatology Alliance COVID-19 registries to investigate this issue.

The study, which was presented at EULAR in June, identified 600 patients with rheumatic disease from 40 countries who had been diagnosed with COVID-19 between March and April.

The study found that patients with rheumatic disease and COVID-19 who were on high doses of glucocorticoids (prednisone dose ≥10 mg/day) were more likely to be hospitalised.

However, patients who were taking csDMARDs (such as methotrexate) alone or in combination with biologics, and patients who were on NSAIDs, did not have an increased risk of hospitalisation after contracting COVID-19.

Patients taking TNF-alpha inhibitors actually had a reduced probability of hospitalisation. And no association was found between the intake of anti-malarial drugs and hospitalisation in the study.

The majority of patients in the registry were women aged 50–65 from North America and Europe. The patient cohort were largely never smokers (75%) who were in remission or had low disease activity (80%).

In the study, the vast majority of the patients with rheumatic disease who caught COVID-19 survived, although 55 patients (9%) died. Around half of patients were hospitalised (46%).

However, this shouldn’t be interpreted as the true rate of hospitalisation and mortality because the way the data was collected by these registries meant that mild or asymptomatic cases were less likely to be reported, the study authors said.

“The study shows that most patients with rheumatological conditions recover from COVID-19 – independent of the medication they receive,” said Professor John Isaacs, a rheumatologist from The University of Newcastle in the UK.

“It is necessary, however, to gather more knowledge about the course of an infection with the novel coronavirus in patients with inflammatory rheumatic conditions.”

EULAR virtual also saw a number of other intriguing COVID-19-related abstracts being presented, including one by an Italian research team.

This team from the IRCCS San Raffaele Scientific Institute in Milan presented promising data around use of mavrilimumab as a treatment for severe COVID-19 pneumonia, hypoxia, and systemic hyperinflammation.

Theirs was a small prospective study in which 13 patients were given the monoclonal antibody mavrilimumab and 26 patients were given standard care.

During the month-long follow-up, zero patients in the mavrilimumab group died, while seven (27%) patients in the control group died.

The researchers reported in The Lancet Rheumatology that mavrilimumab treatment was well-tolerated and was associated with improved clinical outcomes compared with standard care.

However, as with most early COVID-19 treatment research, confirmation of efficacy would require controlled testing, the authors said.

Annals of the Rheumatic Diseases 2020, 14 June

The Lancet Rheumatology 2020, 16 June

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