Autoimmune disease, rituximab linked to higher risk for severe COVID-19 pneumonia
Patients with inflammatory rheumatic disease, but especially those with autoimmune conditions, as well as those treated with rituximab, may be at greater risk for severe COVID-19 pneumonia than the general population, according to data.
“Patients with inflammatory rheumatic diseases (IRD) are at higher risk of general infection due to the presence of comorbidities, the underlying disease activity and the use of targeted immune-modulating therapies,” Javier Bachiller-Corral, MD, of Hospital Universitario Ramón y Cajal, in Madrid, Spain, and colleagues wrote in The Journal of Rheumatology.
“Immunosuppressive targeted therapies (ITT) (biologics and janus kinase inhibitors) have been associated with a higher immunosuppression and an increase in bacterial and viral infections,” they added. “It is unknown whether patients diagnosed with IRD are at risk of suffering a severe course of COVID-19.”
To analyze patients with inflammatory rheumatic disease who are hospitalized with COVID-19, and examine the possible risk for severe COVID-19 based on type of rheumatic disease and immunosuppressive therapy, compared with those without inflammatory rheumatic disease, Bachiller-Corral and colleagues conducted a retrospective, single-center observational study at Ramón y Cajal Hospital. According to the researchers, the facility treats 492,745 adult patients aged older than 16 years, including 4,592 who have been previously diagnosed with an inflammatory rheumatic disease and 883 who are receiving biologics or JAK inhibitors.
Among the population are patients diagnosed with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, Sjögren’s syndrome, vasculitis, myopathy, rheumatic polymyalgia and 12 other inflammatory rheumatic diseases, the researchers wrote.
For their study, Bachiller-Corral and colleagues compared the baseline characteristics and notable comorbidities of the 4,592 patients with inflammatory rheumatic disease to 488,153 local individuals from the general population found in the last Spanish national health survey of 2017. In addition, all registries of adult patients with confirmed COVID-19 who were hospitalized at Ramón y Cajal between March 1, 2020, and April 30, 2020, were included in the analysis. In all, 2,315 patients were admitted due to severe COVID-19 pneumonia.
According to the researchers, 1.8% of patients admitted due to severe COVID-19 pneumonia also had an inflammatory rheumatic disease. The OR for hospital admission among patients with inflammatory rheumatic disease was 1.91 (95% CI, 1.41-2.61), compared with those without inflammatory rheumatic disease. ORs for admission were highest among patients with Sjögren’s syndrome (4.9; 95% CI, 1.86-12.94), vasculitis (3.9; 95% CI, 1.27-11.99) and SLE (3.38; 95% CI, 1.28-8.95).
In all, 10 hospitalized patients with inflammatory rheumatic disease died.
Among the patients with inflammatory rheumatic disease, 27 were receiving corticosteroids, 23 were treated with conventional DMARDs, 12 with biologics — including seven with rituximab (Rituxan; Genentech, Biogen), four with anti-TNF therapy and one with abatacept (Orencia, Bristol Myers Squibb) — and one patient was receiving JAK inhibitors. Rituximab was associated with the highest admission odds ratio, at 12.8 (95% CI, 5.82-28.51), while TNF inhibitors demonstrated the lowest, at 0.88 (95% CI, 0.31-2.5), compared with patients not receiving biologics or JAK inhibitors.
“Patients with IRD may be at higher risk of admission for COVID-19 as compared to the reference population,” Bachiller-Corral and colleagues wrote. “This risk seems to be particularly high for those with systemic autoimmune diseases like SLE, [Sjögren’s syndrome] and [vasculitis], and patients undergoing treatment with rituximab. Conversely, treatment with anti-TNF was not associated with a higher rate of severe SARS-CoV-2 illness.”