COVID-19 and Biologic Therapies –No Increased Risk for RA AS PsA Patients
by Dr. David Borenstein M.D. updated 5/2020
An ongoing concern involving individuals with Ankylosing Spondylitis, Rheumatoid Arthritis and others who suffer from autoimmune disease is whether their illness or their therapy increases the risk of dying from COVID-19 infection. A letter appeared in the New England Journal of Medicine reporting the first week in May describing 86 patients with rheumatic disease who were followed for a month with documented or suspected COVID-19 infection. (1)
The illnesses of these patients included psoriatic arthritis (21), rheumatoid arthritis (20), Crohn’s disease (20), ulcerative colitis (17), psoriasis (14), and ankylosing spondylitis (9). The patients were divided into those who were hospitalized and those who remained ambulatory. Of the 86 patients, 62 (72%) were receiving biologic therapies (i.e. adalimumab) or Janus kinase (JAK) inhibitors. Hospitalizations occurred in 16% (14/86) of these patients. Biologic therapy was taken by more individuals who remained ambulatory (55/72) versus those hospitalized (7/14). A greater proportion of patients who were taking disease modifying drugs like corticosteroids, hydroxychloroquine, and methotrexate were hospitalized than those taking biologic drugs. Other characteristics of hospitalized patients were more co-morbidities including hypertension, diabetes, or chronic obstructive pulmonary disease and being elderly.
Of the 14 hospitalized patients, 11 were discharged after an average stay of about 6 days. Two individuals had more severe disease. One individual remained in the intensive care unit at the end of the 1 month study. Another individual expired in the emergency room. Neither of these individuals took biologic therapy for their rheumatic disease. The frequency of hospitalization for rheumatic disease patients in this study was 16% which is consistent with the reported 26% rate which has been reported among COVID-19 infection patients in the general population from the New York City Department of Health and Mental Hygiene.
This study helps answer the question being asked by many rheumatic disease patients. Does my therapy increase my risk of having a worse outcome in regard to COVID-19 infection if I contract the disease? The answer from this study is NO! The risk of contracting COVID-19 depends on an individual’s exposure to the virus. However, the risk for hospitalization is equal or less than the general population. The take home message is keep taking your medicine to control your rheumatic disease.
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Haberman R et al. Covid-19 in Immune-Mediated Inflammatory Diseases – Case Series from New York. N Engl J Med DOI:10.1056/NEJMc20092567