Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry
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Published:2021-05-28
Issue:9
Volume:80
Page:1137-1146
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ISSN:0003-4967
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Container-title:Annals of the Rheumatic Diseases
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language:en
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Short-container-title:Ann Rheum Dis
Author:
Sparks Jeffrey AORCID, Wallace Zachary S, Seet Andrea M, Gianfrancesco Milena A, Izadi Zara, Hyrich Kimme LORCID, Strangfeld AnjaORCID, Gossec LaureORCID, Carmona LoretoORCID, Mateus Elsa F, Lawson-Tovey SaskiaORCID, Trupin Laura, Rush Stephanie, Katz Patricia, Schmajuk Gabriela, Jacobsohn Lindsay, Wise Leanna, Gilbert Emily L, Duarte-García AliORCID, Valenzuela-Almada Maria O, Pons-Estel Guillermo JORCID, Isnardi Carolina A, Berbotto Guillermo A, Hsu Tiffany Y -TORCID, D’Silva Kristin MORCID, Patel Naomi J, Kearsley-Fleet LianneORCID, Schäfer Martin, Ribeiro Sandra Lúcia EuzébioORCID, Al Emadi Samar, Tidblad Liselotte, Scirè Carlo AlbertoORCID, Raffeiner Bernd, Thomas Thierry, Flipo René-Marc, Avouac Jérôme, Seror Raphaèle, Bernardes Miguel, Cunha Maria Margarida, Hasseli RebeccaORCID, Schulze-Koops HendrikORCID, Müller-Ladner Ulf, Specker ChristofORCID, Souza Viviane Angelina de, Mota Licia Maria Henrique daORCID, Gomides Ana Paula MonteiroORCID, Dieudé PhilippeORCID, Nikiphorou ElenaORCID, Kronzer Vanessa LORCID, Singh NamrataORCID, Ugarte-Gil Manuel FORCID, Wallace Beth, Akpabio AkpabioORCID, Thomas RanjenyORCID, Bhana Suleman, Costello Wendy, Grainger Rebecca, Hausmann Jonathan SORCID, Liew Jean W, Sirotich EmilyORCID, Sufka Paul, Robinson Philip CORCID, Machado Pedro MORCID, Yazdany Jinoos
Abstract
ObjectiveTo investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA).MethodsWe analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders.ResultsOf 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity.ConclusionsPeople with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.
Funder
European Alliance of Associations for Rheumatology American College of Rheumatology
Subject
General Biochemistry, Genetics and Molecular Biology,Immunology,Immunology and Allergy,Rheumatology
Cited by
159 articles.
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