COVID-19 outcomes worse in patients with inflammatory arthritis receiving glucocorticoids
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COVID-19 outcomes are worse among patients with inflammatory arthritis receiving glucocorticoids, but not in those receiving anticytokine therapy, according to data published in Arthritis & Rheumatology.
“The COVID-19 pandemic has brought up new questions for both patients and medical professionals,” Rebecca H. Haberman, MD, MSCI, of the New York University School of Medicine and NYU Langone Orthopedic Hospital, told Healio Rheumatology. “Within the world of rheumatology, one of the most common questions was, ‘What do I do with my medications?’ This was especially important as medications for inflammatory arthritis are often thought to be immunosuppressive. There was no clear guidance, so we sought out to fill this gap — to provide answers for patients and doctors alike.”
To analyze hospitalization and death rates among patients with inflammatory arthritis diagnosed with COVID-19, and to examine the links between comorbidities, immunomodulatory medications and outcomes, Haberman and colleagues recruited participants from a larger NYU Langone study, called WARCOV. According to the researchers, WARCOV is a prospective cohort of patients with immune-mediated diseases, which between March 3 and May 4 received 126 case reports of adult patients with inflammatory arthritis, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or inflammatory bowel disease-related arthritis.
For their own study, Haberman and colleagues included 103 patients, 80 of whom had a confirmed diagnosis of COVID-19, with the remaining 23 being highly suspected to have contracted the disease. Clinical, demographic, maintenance treatment and disease course data and outcomes were assessed using a webbased questionnaire followed by individual phone calls and electronic medical record review. The researchers analyzed baseline characteristics and medication use among included participants and used multivariable logistic regression to compare outcomes for each class of medication.
According to the researchers, 26% of participants required hospitalization, and 4% died. Patients who were hospitalized were significantly more likely to be older (P < .001) and demonstrate comorbid hypertension (P = .001) as well as chronic obstructive pulmonary disease (P = .022). In addition, patients receiving oral glucocorticoids had a higher likelihood of being hospitalized for COVID19 (P < .001), while those on maintenance anticytokine biologic therapies did not.
“Coupled with findings from other recent studies, our results should provide reassurance to patients with inflammatory arthritis who are currently taking chronic immunomodulatory medications,” Haberman said. “Patients should not automatically stop their medications but reach out to their rheumatologists to discuss any changes in their care.”
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