Immunosuppressive drugs and COVID-19 –No Increased Risk
by David Borenstein, MD Executive Editor TheSpineCommunity.com 9/2020
An ongoing concern involving individuals who suffer from rheumatic disease is whether their therapy or underlying illness increases the risk of dying from COVID-19 infection. A group of 955 rheumatic disease patients (67.4% females) taking standard disease modifying drugs (DMARDs) or biologics who lived in the Lombardy section of Italy, the center of the COVID-19 in that country, was the study group.1 The frequency and severity of infection was matched against the general population of Lombardy over a 46 day period in the Spring of 2020. The general background population included 8,687,083 people over age 18. The diagnosis of Covid-19 was established by nasopharyngeal swab.
The illnesses of the patients included rheumatoid arthritis (531), psoriatic arthritis (203), ankylosing spondylitis (181), systemic lupus (13), systemic sclerosis (3), Sjogren’s syndrome (2), Behcet’s (6), giant cell arteritis (3), adult-onset Still’s disease, juvenile idiopathic arthritis (5), autoinflammatory diseases (4), and sarcoidosis (1). The average age was 53.7 years with disease duration of 13.9 years. A majority of patients were taking anti-tumor necrosis factor antibody (55.8%), abatacept (11.8%), interleukin-6 inhibitors (10.3%), JAK inhibitors (10.1%), interleukin – 17 inhibitors (4.7%), rituximab (1.7%), interleukin-12/23 inhibitor (1.5%), and belimumab (1.3%).
A total of 6 patients, 3 with rheumatoid arthritis, 2 with ankylosing spondylitis, and 1 with sarcoidosis developed Covid-19 infection. Five of these patients were treated with anti-TNF ( 3 etarnercept, 1 adalimumab, and 1 infliximab), and 1 with abatacept. Four of the infected patients also took methotrexate (2), leflunomide (1), or sulfasalazine (1), along with 2 treated with hydroxychloroquine. Three patients were hospitalized. None were admitted to the intensive care unit. Their rheumatic disease treatment was temporarily discontinued when hospitalized. Two of these had a relapse of disease while off therapy. The incidence of confirmed Covid cases was 0.62% and was consistent with the 57,892 general population cases (0.66%). Individuals on hydroxychloroquine did develop of the infection.
As shown in a cohort of patients from New York City2, rheumatic disease patients who are taking DMARD or biologic therapy are NOT at increased risk of developing or dying from Covid-19 infection. Some patients who discontinue therapy at the time of infection are at risk of developing a flare of disease off therapy. Resuming therapy can reestablish control of the rheumatic disease. Methods to limit exposure to Covid -19 (mask-wearing, hand wahsing, physical distancing) is encouraged.'
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Favalli EG, et al.Arthritis Rheumatol. 2020 Jun 7:10.1002/art.41388. doi: 10.1002/art.41388.
Haberman R et al. Covid-19 in Immune-Mediated Inflammatory Diseases – Case Series from New York. N Engl J Med DOI:10.1056/NEJMc20092567