COVID-19 infection rate in patients treated with DMARDs consistent with general population
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The incidence and severity of COVID-19 among patients with rheumatic disease treated with targeted synthetic or biological DMARDs is consistent with those in the general population, according to data published in Arthritis & Rheumatology.
“Along with the growth of the worldwide health emergency, there has been an increasing need to clarify the incidence and course of COVID-19 in immunosuppressed rheumatic patients in order to optimize their management strategy,” Ennio Giulio Favalli, MD, of the ASST Gaetano Pini-CTO Institute, in Milan, and colleagues wrote. “On the one hand, in fact, many chronic immune-mediated inflammatory diseases are characterized by an overall intrinsic increase in infectious risk, demonstrated specifically for viral infections such as influenza.”
“Interestingly, this risk tends to increase proportionally to the degree of disease activity and is minimal in patients in sustained remission,” they added. “On the other hand, both conventional and targeted disease-modifying drugs (DMARDs) may be an additional iatrogenic risk factor, although many of them are currently being tested for COVID-19-induced [cytokine release storm]. To date, data on the epidemiology of COVID-19 in rheumatic populations are very scarce.”
To examine the incidence and severity of COVID-19 among patients treated with targeted synthetic or biological DMARDs, compared with the general population of the same region in Italy, Favalli and colleagues analyzed data from two rheumatology referral centers in Lombardy. From Feb. 25 to April 10, the researchers invited patients to participate in a survey to identify those with confirmed COVID-19, close contacts with known COVID-19, infection symptoms, and changes in work, behavior and disease management.
A total of 955 patients received the survey, including 531 with rheumatoid arthritis, 203 with psoriatic arthritis, 181 with spondyloarthritis and 40 with connective tissue disease, vasculitides or autoinflammatory diseases. The response rate was 98.05%. The researchers calculated the COVID-19 incidence rate among the general population in Lombardy using data from the National Institute of Statistics. All cases of confirmed COVID-19 were defined using nasopharyngeal swab.
According to the researchers, the incidence rate of confirmed COVID19 was 0.62% among patients with rheumatic disease receiving DMARDs, compared with 0.66% among the general population (P = .92). None of the patients had severe complications or required intensive care treatment, and all temporarily discontinued ongoing immunosuppressive therapy. About 90.6% of patients adopted precautions to prevent the contagion, while 93.2% maintained the ongoing treatment with DMARDs. Disease activity remained stable in 89.5% of patients.
“The use of biological or targeted synthetic drugs in rheumatic patients has proven safe during the COVID-19 epidemic,” Favalli and colleagues wrote.
“Maintaining the ongoing chronic treatment for the underlying rheumatologic disease has minimized the number of disease flare-ups, which are associated with a general deterioration of the patient's condition and must absolutely be prevented in such an emergency period,” they added. “Obviously, it is essential to maintain a high level of surveillance on rheumatic patients, who must be encouraged to apply even more rigorously all the prevention rules for contagion that are already recommended for the general population.”
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