Identification of Risk Factors for COVID-19 Hospitalization in Patients with Anti-Rheumatic Drugs: Results from a Multicenter Nested Case Control Study
Opdam et al.,
Identification of Risk Factors for COVID-19 Hospitalization in Patients with Anti-Rheumatic Drugs: Results..,
Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2551
Retrospective 81 cases and 396 controls among rheumatic disease patients in the Netherlands, showing lower risk of hospitalization with HCQ prophylaxis, without statistical significance.
risk of hospitalization, 45.0% lower, OR 0.55, p = 0.18, treatment 8 of 81 (9.9%) cases,
59 of 396 (14.9%) controls, NNT 17, case control OR.
|
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
|
Opdam et al., 23 Feb 2022, retrospective, Netherlands, peer-reviewed, 9 authors.
Abstract: BRIEF REPORT
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. Opdam1,*, Sophie Benoy2, Lise M. Verhoef1, Sandra Van Bijnen3, Femke Lamers-Karnebeek4,
René A. M. Traksel2, Petra Vos5, Alfons A. den Broeder1 and Jasper Broen2
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.
Study Highlights
WHAT IS THE CURRENT KNOWLEDGE ON THE
TOPIC?
The majority of the studies performed on coronavirus disease 2019 (COVID-19) risk in inflammatory rheumatic diseases
(IRDs) show no increased risk for severe COVID-19 in these
patients, who often receive immunosuppressive antirheumatic
drugs. Case-control studies are, however, a scarce commodity
and most of the data is derived from registry-based studies.
WHAT QUESTION DID THIS STUDY ADDRESS?
In this study, we aimed to determine whether certain patients with IRD carry a higher risk for COVID-19-related
hospitalization, for example, due to the use of antirheumatic
agents.
WHAT DOES THIS STUDY ADD TO OUR
KNOWLEDGE?
The overall finding that no specific antirheumatic drugs
or IRD enhances the risk of severe COVID-19, requiring hospitalization, is reassuring for patients and medical personnel.
Additionally, the finding that methotrexate has a possible protective effect for severe COVID-19 is of high interest in an enduring pandemic and still imperfect protection by vaccination.
HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?
Our finding might spark interest in further investigations
into methotrexate as an avenue for prospective clinical investigation in COVID-19 treatment and prevention.
1
Department of..
Please send us corrections, updates, or comments. Vaccines and
treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, or intervention
is 100% available and effective for all current and future variants. We do not
provide medical advice. Before taking any medication, consult a qualified
physician who can provide personalized advice and details of risks and
benefits based on your medical history and situation.
FLCCC and
WCH
provide treatment protocols.
Submit