Biological agents for rheumatic diseases in the outbreak of COVID-19: friend or foe?

• Published in: Rheumatic & musculoskeletal diseases open 2021-01, Vol.7 (1), p.e001439
• Main Authors: Santos, Cristiana Sieiro, Férnandez, Xenia Cásas, Moriano Morales, Clara, Álvarez, Elvira Díez, Álvarez Castro, Carolina, López Robles, Alejandra, Pérez Sandoval, Trinidad
• Format: Article
• Language: English
• Subjects: Age; Aged; Antibodies, Monoclonal, Humanized - pharmacology; Antibodies, Monoclonal, Humanized - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis; autoimmunity; Biological Factors - therapeutic use; biological therapy; Cardiovascular disease; Coronaviruses; COVID-19; COVID-19 - drug therapy; COVID-19 - epidemiology; Cytokines; Diabetes; Disease Outbreaks; Drug dosages; epidemiology; Female; Glucocorticoids - therapeutic use; Humans; Hypertension; Infection; Infections; Interleukin-6 - antagonists & inhibitors; Male; Middle Aged; Monoclonal antibodies; Population; Prescription drugs; Protective Agents - therapeutic use; Retrospective Studies; Rheumatic diseases; Rheumatic Diseases - drug therapy; Rheumatology; Risk Factors; Rituximab - therapeutic use; SARS-CoV-2 - genetics; SARS-CoV-2 - immunology; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome coronavirus 2; Spain - epidemiology; Treatment Outcome; Tumor necrosis factor-TNF
• ISSN: 2056-5933; 2056-5933
• DOI: 10.1136/rmdopen-2020-001439

BackgroundThe recent outbreak of COVID-19 has raised concerns in the rheumatology community about the management of immunosuppressed patients diagnosed with inflammatory rheumatic diseases. It is not clear whether the use of biological agents may suppose a risk or protection against SARS-CoV-2 infection; however, it has been suggested that severe respiratory forms of COVID-19 occur as a result of exacerbated inflammation status and cytokine production. This prompted the use of interleukin 6 (IL-6) (tocilizumab and sarilumab) and IL-1 inhibitors (anakinra) in severe COVID-19 disease and more recently JAK1/2 inhibitor (baricitinib). Therefore, patients with rheumatic diseases provide a great opportunity to learn about the use of biological agents as protective drugs against SARS-CoV-2.ObjectivesTo estimate COVID-19 infection rate in patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) for inflammatory rheumatic diseases (RMD), determine the influence of biological agents treatment as risk or protective factors and study the prognosis of patients with rheumatic diseases receiving biological agents compared to the general population in a third-level hospital setting in León, Spain.MethodsWe performed a retrospective observational study including patients seen at our rheumatology department who received bDMARDs for rheumatic diseases between December 1st 2019 and December 1st 2020, and analysed COVID-19 infection rate. All patients who attended our rheumatology outpatient clinic with diagnosis of inflammatory rheumatic disease receiving treatment with biological agents were included. Main variable was the hospital admission related to COVID-19. The covariates were age, sex, comorbidities, biological agent, duration of treatment, mean dose of glucocorticoids and need for intensive care unit . We performed an univariate and multivariate logistic regression models to assess risk factors of COVID-19 infection.ResultsThere were a total of 4464 patients with COVID-19 requiring hospitalisation. 40 patients out of a total of 820 patients with rheumatic diseases (4.8%) receiving bDMARDs contracted COVID-19 and 4 required hospital care. Crude incidence rate of COVID-19 requiring hospital care among the general population was 3.6%, and it was 0.89% among the group with underlying rheumatic diseases. 90% of patients receiving bDMARDS with COVID-19 did not require hospitalisation. Out of the 4464 patients, 869 patients died, 2 of which received t