Identification of Risk Factors for COVID‐19 Hospitalization in Patients With Anti‐Rheumatic Drugs: Results From a Multicenter Nested Case Control Study
Merel A A Opdam, Sophie Benoy, Lise M Verhoef, Sandra Van Bijnen, Femke Lamers‐karnebeek, René A M Traksel, Petra Vos, Alfons A Den Broeder, Jasper Broen
Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2551
Patients with inflammatory rheumatic diseases (IRDs) do not have an increased risk for coronavirus disease 2019 (COVID-19) compared with the general population. However, it remains uncertain whether subgroups of patients with IRD using different immunosuppressive antirheumatic drugs carry a higher risk for severe COVID-19 compared with other patients with IRD. The aim of this study is to identify risk factors for severe COVID-19, requiring hospitalization in patients with IRD. This is a multicenter nested case control study conducted in the Netherlands. Cases are hospital known patients with IRD requiring hospitalization for COVID-19 between March 1, 2020, and May 31, 2020. Controls are hospital known patients with IRD not requiring hospitalization for COVID-19 in this period, included at a 4:1 ratio. Patient, disease, and treatment characteristics were extracted from electronic medical records and a questionnaire. Potential risk factors were analyzed using unconditional logistic regression, corrected for confounders and multiple testing. Eighty-one cases and 396 controls were included. General risk factors of older age and obesity apply to patients with IRD as well (odds ratio (OR) for age ≥75 3.5, 95% confidence interval (CI) 1.9-6.3, OR for body mass index ≥40 4.5, 95% CI 1.5-14). No significantly increased ORs for COVID-19 hospitalization were found for any antirheumatic agent or IRD. A protective effect was found for use of methotrexate (OR 0.53, 95% CI 0.31-0.92). In conclusion, similar to the general population, elderly and obese patients with IRD have a higher risk for hospitalization for COVID-19. We did not identify a specific antirheumatic agent or IRD to increase the risk of COVID-19 hospitalization in patients with IRD, except for a possible protective effect of methotrexate.
SUPPORTING INFORMATION Supplementary information accompanies this paper on the Clinical Pharmacology & Therapeutics website (www.cpt-journal.com).
ACKNOWLEDGMENTS The authors would like to thank the research assistants who contributed to data collection. Preliminary results of this study were presented as a poster at the EULAR conference 2021. 20
FUNDING This work was supported by a research grant from Gilead Sciences.
CONFLICTS OF INTEREST M.O. reports received grants (to the institution) from Gilead Sciences. A.d.B. has received consultancy honoraria, congress invitations, and research grants (to the institution) from Abbvie, Amgen, Cellgene, Roche, Biogen, Lilly, Novartis, Celltrion Sanofi, and Gilead. Is coinventor on a rituximab related patent (pending). J.B. has received consultancy fees from Novartis, UCB, Gilead, and Galapagos. All other authors declared no competing interests for this work.
AUTHOR CONTRIBUTIONS All authors wrote the manuscript. M.O., S.B., L.V., R.T., A.dB., and J.B. designed the research. M.O., S.B., J.B., S.vB., F.L., and P.V. performed the research. M.O., A.dB., and J.B. analyzed the data.
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