COVID-19 presentation and outcomes in patients with inflammatory rheumatic and musculoskeletal diseases receiving IL6-receptor antagonists prior to SARS-CoV-2 infection

• Published in: Journal of translational autoimmunity (Online) 2023-01, Vol.6, p.100190-100190, Article 100190
• Main Authors: Comarmond, Cloé, Drumez, Elodie, Labreuche, Julien, Hachulla, Eric, Thomas, Thierry, Flipo, René-Marc, Seror, Raphaëlle, Avouac, Jérôme, Balandraud, Nathalie, Desbarbieux, Renaud, Felten, Renaud, Gilson, Mélanie, Guyot, Marie-Hélène, Hittinger-Roux, Ambre, Pham, Thao, Renard, Myriam, Roux, Nicolas, Sobanski, Vincent, Tournadre, Anne, Richez, Christophe, Cacoub, Patrice
• Format: Article
• Language: English
• Subjects: Anti-IL6; COVID-19; Inflammatory rheumatic and musculoskeletal diseases; Life Sciences
• ISSN: 2589-9090; 2589-9090
• DOI: 10.1016/j.jtauto.2023.100190

COVID-19 outcome may be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases (RMD) receiving immunosuppressive therapy. We aimed to investigate whether RMD patients on anti-IL6 therapy prior to SARS-CoV-2 infection have less severe disease and better outcomes of COVID-19. We conducted a retrospective national, multicentre cohort study using data from the French RMD COVID-19 cohort. We compared the severity and outcome of highly suspected or confirmed COVID-19 infection in RMD patients previously treated with tocilizumab or sarilumab (anti-IL6 group) with patients who did not receive anti-IL6 therapy (no anti-IL6 group). Data were collected for 1883 patients with mean age of 55.2 years [SD 16.7] and 1256 (66.7%) female. Two hundred ten (11.1%) developed severe COVID-19 and 115 (6.4%) died. After adjusting for potential confounding factors, severe COVID-19 was less frequent in the anti-IL6 group compared with the no anti-IL6 group (aOR for moderate vs. mild severity, 0.23 [95% CI, 0.10 to 0.54], p ≤ 0.01 and aOR for severe vs. mild, 0.29 [95% CI, 0.10 to 0.81], p ≤ 0.01). No significant differences were found for the evolution of COVID-19 between the anti-IL6 group and the no anti-IL6 group (aOR for recovery with sequelae vs recovery without sequelae, 0.78 [95% CI, 0.41 to 1.48] and aOR for death vs recovery without sequelae, 0.29 [95% CI, 0.07 to 1.30]). RMD patients receiving anti-IL6 therapy prior to SARS-CoV-2 infection have less severe forms of COVID-19. No difference was observed in COVID-19 evolution, i.e., sequelae or death, between the groups. •RMD patients who receive anti-IL6 agents prior to SARS-CoV-2 infection have less severe COVID-19, with less frequent hospitalisation and respiratory support than their counterparts.•Our results provide reassurance to clinicians using anti-IL6 agents in RMD patients before SARS-CoV-2 infection, thereby supporting the recommendation to not withhold anti-IL6 therapy during the COVID-19 pandemic.