COVID-19 and Rheumatology

COVID-19 and Rheumatology

Disclosures: The researchers report no relevant financial disclosures.
January 07, 2021
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Steroids, not DMARDs, increase risk for COVID-19 infection in inflammatory arthritis

Disclosures: The researchers report no relevant financial disclosures.
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Glucocorticoids, even at a low dose, may increase the risk for COVID-19, while immunomodulatory treatments appear safe for patients with inflammatory arthritis, according to data published in Arthritis Research & Therapy.

“COVID-19 and immunosuppression are indeed coupled by a complex and possibly bidirectional relationship,” Ennio Giulio Favalli, MD, of the ASST Gaetano Pini-CTO Institute, in Milan, and colleagues wrote. “On the one hand, in fact, glucocorticoids (GC), cytokine blockers, or small molecules inhibiting Janus kinases (JAK) could theoretically mitigate the hyper-immune reactions responsible of more severe manifestations of COVID-19. Accordingly, immunomodulating agents are currently being trialed in the treatment of SARS-CoV-2 infection.”

Glucocorticoids, even at a low dose, may increase the risk for COVID-19, while immunomodulatory treatments appear safe, according to data. Source: Adobe Stock

“However, concern remains on the possible impact of these same immunosuppressive therapies on increasing the risk of COVID-19 or worsening its clinical course in patients on chronic treatment for immune-mediated inflammatory diseases (IMIDs),” they added. “As IMIDs are highly prevalent in Western societies (approximately 5% to 7%) and routine use of GC and synthetic and biological disease-modifying drugs has become widespread in rheumatology, gastroenterology, and dermatology, understanding the real impact of immunosuppression on COVID-19 diffusion and severity undoubtedly represents a crucial issue of inter-disciplinary relevance.”

To examine affect of glucocorticoids and immunosuppressive drugs on the risk for COVID-19 among patients with chronic immune-mediated inflammatory arthritis, Favalli and colleagues conducted a cross-sectional survey of patients at two large academic hospital in Lombardy, the most endemic area of Northern Italy. Specifically, the researchers included all adult patients diagnosed with rheumatoid arthritis, undifferentiated arthritis, psoriatic arthritis or spondyloarthritis, with a follow-up visit scheduled in the period between Feb. 25 and April 20, 2020.

The survey, conducted via telephone or face-to-face, explored the prevalence of confirmed severe acute respiratory syndrome-coronavirus-2 nasopharyngeal and the occurrence of acute respiratory illness, such as fever, cough or dyspnea. Cases of COVID-19 were defined as confirmed or highly suspicious based on WHO criteria. In all, 2,050 patients receiving glucocorticoids, conventional-synthetic DMARDS, or targeted-synthetic/biological DMARDs were included in the study.

According to the researchers, 1.1% of participants demonstrated laboratory-confirmed COVID-19, while 1.4% had highly suspicious infection. Glucocorticoids were independently associated with an increased risk for COVID-19. The adjusted OR ranged from 1.23 (95% CI, 1.04-1.44) to 3.2 (95% CI, 1.97-5.18) depending on the definition used. Meanwhile, patients who received targeted-synthetic/biological DMARDs had a reduced risk, with adjusted ORs ranging from 0.46 (95% CI, 0.18-1.21) to 0.47 (95% CI, 0.46-0.48). The researchers recorded no independent effects regarding conventional-synthetic DMARDs, age, sex and comorbidities.

“This study provides all specialists facing the COVID-19 emergency with a very reassuring message about the possibility of suggesting RMDs patients to continue their current therapy with ts/bDMARDs without an increased risk and probably with a milder infection course,” Favalli and colleagues wrote. “Conversely, the use of GC especially a dose >2.5mg per day should be cautiously evaluated during the pandemic.”