Rituximab increased odds of COVID-19 hospitalization vs. DMARDs for patients with RA
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Baseline use of rituximab compared with conventional synthetic disease-modifying antirheumatic drugs was associated with worse COVID-19 outcomes in patients with rheumatoid arthritis, according to a presenter at ACR Convergence 2021.
“The COVID-19 pandemic led to several questions regarding the safety of DMARDs that patients with rheumatic diseases use for their management,” Namrata Singh, MD, MSCIFACP, assistant professor at the University of Washington, told Healio.
Among different DMARDs, rituximab (Rituxan, Genentech) has a unique mechanism of action with depletion of B cells that can last for several months, Singh said. “Therefore, we undertook our study with the aim to shed light on the comparative safety of rituximab compared with other DMARDs in patients with RA.”
In a retrospective cohort study, Singh and colleagues included 69,549 patients with RA from the National COVID Cohort Collaborative, of which 22,956 were diagnosed as COVID-19 positive on or after January 1, 2020.
In multivariable-adjusted models, baseline use of rituximab in those diagnosed with COVID-19 was associated with increased odds of hospitalization (OR = 2.14; 95% CI, 1.51-3.04), ICU admission (OR = 5.22; 95% CI, 1.77-15.41) and invasive ventilation (OR = 2.74; 95% CI, 1.36-5.51) compared with the use of conventional synthetic DMARDs.
Patients who had recent rituximab use were associated with a higher risk of 30-day mortality compared with those whose last infusion was more than 180 days prior. However, rituximab use was not associated with severe/fatal COVID-19 (adjusted OR = 1.66; 95% CI, 0.89-3.08).
“Interestingly, in our study, we did not find an association between rituximab use and mortality from COVID-19,” Singh told Healio. “This is in contrast to a few other studies that did observe an association. We speculate that this could be because prior studies did not adequately adjust for COVID-19 treatments, especially those used during COVID-19 hospitalization, as we did in our analyses.”
No DMARD use was also found to be associated with significantly higher odds of hospitalization in patients diagnosed with COVID-19, according to the study.
“Findings from our study can guide patients, providers and policymakers regarding the increased risks associated with rituximab use during the COVID-19 pandemic,” the researchers said in the presentation.
The data also highlight the need for continued vigilance of patients on rituximab, the need for COVID-19 vaccination and boosters, and continuation of the other preventive measures, including masking, social distancing and avoiding unnecessary travel, Singh told Healio.
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Singh N, et al. Abstract #1445. Presented at: ACR Convergence 2021; November 3-10, 2021 (virtual meeting).
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