Influence of biologic and conventional disease-modifying antirheumatic drugs on COVID-19 incidence among rheumatic patients during the first and second wave of the pandemic in Iran
Maryam Sahebari, Zahra Mirfeizi, Zhaleh Shariati-Sarabi, Malihe Moghadam, Kamila Hashemzadeh, Mona Firoozabadi
Rheumatology, doi:10.5114/reum.2022.119039
Introduction: During the SARS-CoV-2 virus pandemic, immunosuppressive agents in treating chronic disease have become a concern, and rheumatic patients are not an exception. The controversies about the deteriorating effects of such medications led this study to evaluate the influence of biologic and conventional disease-modifying antirheumatic drugs (DMARDs) on the incidence of COVID-19 infection in rheumatic patients. Material and methods: In the present cohort-analytical study, 512 patients with rheumatic diseases were enrolled during the COVID-19 pandemic (2020COVID-19 pandemic ( -2021)). The incidence of COVID-19 infection was diagnosed according to the definition of the Iranian Ministry of Health. The frequency of COVID-19 infection in patients treated with biological and conventional DMARDs and glucocorticosteroids were compared. Results: Among 512 rheumatic patients, 19.9% were definitely infected with COVID-19, and 23.3% of infected patients were hospitalized. Only one patient with vasculitis died during the two outbreaks. Our study showed that adding biologic DMARDs to conventional DMARDs did not increase the risk of COVID-19 infection. However, unlike biologic DMARDs, in conventional DMARDs, methotrexate increased, and hydroxychloroquine decreased COVID-19 infection. Regression analysis showed that prednisolone at a dosage higher than 10 mg/day increased the risk of COVID-19 infection 5-fold; hydroxychloroquine had a protective impact and reduced the risk of infection by 40%. Conclusions: Biologic DMARDs and the type of selected rheumatic diseases in our study did not influence the susceptibility to COVID-19 infection. Prednisolone raised the coronavirus infection, and hydroxychloroquine played a protective role in the current study. Most of our patients showed good adherence to the health protocols. Further studies after worldwide vaccination are now required to reevaluate the influence of rheumatic diseases and DMARDs on COVID-19 infection.
References
Akiyama, Hamdeh, Micic, Sakuraba, Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-218946Avouac, Drumez, Hachulla, COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study, Lancet Rheumatol,
doi:10.1016/S2665-9913(21)00059-XBaloch, Baloch, Zheng, Pei, The coronavirus disease 2019 (COVID-19) pandemic, Tohoku J Exp Med,
doi:10.1620/tjem.250.271Conticini, Bargagli, Bardelli, COVID-19 pneumonia in a large cohort of patients treated with biological and targeted synthetic antirheumatic drugs, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217681De Wit, Smolen, Gossec, Van Der Heijde, Treating rheumatoid arthritis to target: the patient version of the international recommendations, Ann Rheum Dis,
doi:10.1136/ard.2010.146662Edwards, Cahalan, Mensing, Pain, catastrophizing, and depression in the rheumatic diseases, Nat Rev Rheumatol,
doi:10.1038/nrrheum.2011.2Favalli, Bugatti, Klersy, Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis, Arthritis Res Ther,
doi:10.1186/s13075-020-02395-6Gianfrancesco, Hyrich, Al-Adely, Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217871Michaud, Wipfler, Shaw, Experiences of patients with rheumatic diseases in the United States during early days of the COVID-19 pandemic, ACR Open Rheumatol,
doi:10.1002/acr2.11148Migkos, Kaltsonoudis, Pelechas, Use of conventional synthetic and biologic disease-modifying anti-rheumatic drugs in patients with rheumatic diseases contracting COVID-19: a single-center experience, Rheumatol Int,
doi:10.1007/s00296-021-04818-2Monti, Balduzzi, Delvino, Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-217424Moore, Pilkington, Kumar, Diseases with health disparities as drivers of COVID-19 outcome, J Cell Mol Med,
doi:10.1111/jcmm.15599Mori, Past hepatitis B virus infection in rheumatoid arthritis patients receiving biological and/or nonbiological diseasemodifying antirheumatic drugs, Modern Rheumatol,
doi:10.1007/s10165-011-0458-zRheumatism, EULAR Guidance for patients COVID-19 outbreak, Web Site
Schwaneck, Krone, Kreissl-Kemmer, Management of anti-HBc-positive patients with rheumatic diseases treated with disease-modifying antirheumatic drugs -a single-center analysis of 2054 patients, Clinical Rheumatol,
doi:10.1007/s10067-018-4295-8Schälter, Dürholz, Bucci, Does methotrexate influence COVID-19 infection? Case series and mechanistic data, Arthritis Res Ther,
doi:10.1186/s13075-021-02464-4Strangfeld, Schäfer, Gianfrancesco, Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry, Ann Rheum Dis,
doi:10.1136/annrheumdis-2020-219498Strehl, Ehlers, Gaber, Buttgereit, Glucocorticoidsall-rounders tackling the versatile players of the immune system, Front Immunol,
doi:10.3389/fimmu.2019.01744Stricker, Fesler, Hydroxychloroquine pre-exposure prophylaxis for COVID-19 in healthcare workers from India: a meta-analysis, J Infect Public Health,
doi:10.1016/j.jiph.2021.08.001Tan, Zhou, Zhao, Wei, Prospective study of HBV reactivation risk in rheumatoid arthritis patients who received tional disease-modifying antirheumatic drugs, Clin Rheumatol,
doi:10.1007/s10067-012-1988-2Tursi, Papa, Impact of anti-tnfα antibodies on the risk of COVID-19 and its severity in patients with inflammatory bowel diseases, J Crohns Colitis,
doi:10.1093/ecco-jcc/jjaa076Wambier, Goren, Vaño-Galván, Androgen sensitivity gateway to COVID-19 disease severity, Drug Dev Res,
doi:10.1002/ddr.21688Wang, Qi, Bao, A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units, Lancet Child Adolesc Health,
doi:10.1016/S2352-4642(20)30040-7Wong, Cvijanovich, Allen, Corticosteroids are associated with repression of adaptive immunity gene programs in pediatric septic shock, Am J Respir Crit Care Med,
doi:10.1164/rccm.201401-0171OCZhang, Rostami, Leopold, Expression of the SARS-CoV-2 ACE2 receptor in the human airway epithelium, Am J Respir Crit Care Med,
doi:10.1164/rccm.202003-0541OCZheng, Peng, Xu, Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis, J Infect,
doi:10.1016/j.jinf.2020.04.021
