NYC case series indicates biologics, JAK inhibitors did not worsen COVID-19 outcomes
Baseline use of biologics and JAK inhibitors among patients with immune-mediated inflammatory disease, such as rheumatoid arthritis, psoriatic arthritis, psoriasis and other related conditions, is not associated with worse COVID-19 outcomes, according to a case series presented in the New England Journal of Medicine.
“Since the start of this pandemic, we have been fielding one particular call from our patients, and some colleagues — what should I do about my medications?” Rebecca Haberman, MD, of New York University Langone Health, told Healio Rheumatology. “Rheumatologists have been lacking any concrete evidence regarding what to advise our patients. Here, we try to fill some of those gaps and present what we have learned from our patient population to the general community.”
In their prospective case series, presented in a letter to the editor, Haberman and colleagues reported on 86 established patients at New York University Langone Health with known immune-mediated inflammatory disease (IMIDs) — including RA, PsA, ankylosing spondylitis, psoriasis, inflammatory bowel disease or related conditions — as well as either confirmed or highly suspected COVID-19 infection. These patients, of whom 59 were confirmed to have COVID-19, with 27 being highly suspected cases, were assessed from March 3 through April 3, with an average follow-up of 16 days from symptom outset.
The physicians analyzed patients’ clinical and demographic data, comparing those who required hospitalization to those who did not. Among the 86 total patients, 72% were receiving biologics or JAK inhibitors. The overall incidence rate for hospitalization was 16%. According to the physicians, patients who required hospitalization were older, compared with those who did not.
In addition, although there was a similar distribution of IMID diagnoses across the ambulatory and hospitalized groups, a higher percentage of the latter population had RA. The hospitalized group also had more patients with coexisting hypertension, diabetes or COPD.
According to the authors, 76% of ambulatory patients were receiving biologics or JAK inhibitors at baseline, compared with 50% of those who required hospitalization, with an overall incidence of hospitalization among patients who had received these medications long-term of 11%. However, even after multivariate analysis, the use of oral glucocorticoids — 29% in hospitalized patients vs. 6% in ambulatory patients — hydroxychloroquine — 21% vs. 7% — and methotrexate — 43% vs. 15% — was higher among those in the hospitalized group. These observations were also consistent when limited to only patients with confirmed COVID-19.
In addition, among the 14 patients with IMIDs who were hospitalized, 79% were discharged, following a mean stay of 5.6 days, while two patients remained hospitalized as of April 3. Among the two patients with more severe disease, one demonstrated elevated IL-6 levels and received mechanical ventilation for acute respiratory distress syndrome. The other patient died in the emergency department. Neither of these two patients were receiving biologics on a long-term basis.
“In our patients with immune-mediated inflammatory diseases on chronic biologics, we found that they do not have worse COVID-19 outcomes than the general New York City population,” Haberman said. “Certainly, this needs to be further validated, but it should be somewhat reassuring for patients and clinician alike.”