TNF inhibitors, methotrexate may not worsen outcomes in COVID-19

Patients being treated with tumor necrosis factor inhibitors or methotrexate who acquired COVID-19 did not experience elevated hospitalization or mortality rates, according to a study.

Data are scarce regarding the impact of biologics and immunomodulators on COVID-19-related outcomes. “We sought to determine whether patients taking tumor necrosis factor inhibitors (TNFis) or methotrexate are at increased risk of COVID-19-related outcomes,” Ahmed Yousaf, BA, of the department of dermatology at West Virginia University, and colleagues wrote.

The initial cohort included 53,511,836 unique patient records, of which 32,076 were individuals with a COVID-19-related diagnosis documented at some point after Jan. 20, 2020; 214 patients with COVID-19 had had recent exposure to TNFis or methotrexate. Researchers compared outcomes in these patients with those reported for the 31,862 patients with COVID-19 who were not exposed to those drugs.

There was no significant difference in hospitalization rates between patients who were treated with the drugs and those who were not (RR = 0.91; 95% CI, 0.68-1.22). Similarly, mortality rates did not differ between the treatment and nontreatment groups (RR = 0.87; 95% CI, 0.42-1.78).

The trend persisted in subgroup analyses. There was no increased risk for hospitalization among individuals with COVID-19 treated with TNFis (RR = 0.73; 95% CI, 0.47-1.14) or methotrexate (RR = 0.87; 95% CI, 0.62-1.23).

The researchers acknowledged the limitation that all TNF inhibitors may not behave the same.

“Our study suggests that patients with recent TNFi or methotrexate exposure do not have increased hospitalization or mortality compared with patients with COVID-19 without recent TNFi or methotrexate exposure,” the researchers wrote. “Our study supports the ongoing use of TNFi or [methotrexate] therapy and argues against the interruption of treatment because of the fear of possibly worse COVID-19-related outcomes.”