The protective effect of tumor necrosis factor-alpha inhibitors in COVID-19 in patients with inflammatory rheumatic diseases compared to the general population-A comparison of two German registries

• Published in: Frontiers in medicine 2024-03, Vol.11, p.1332716
• Main Authors: Hasseli, Rebecca, Hanses, Frank, Stecher, Melanie, Specker, Christof, Weise, Tobias, Borgmann, Stefan, Hasselberger, Martina, Hertenstein, Bernd, Hower, Martin, Hoyer, Bimba F, Koll, Carolin, Krause, Andreas, von Lilienfeld-Toal, Marie, Lorenz, Hanns-Martin, Merle, Uta, Nunes de Miranda, Susana M, Pletz, Mathias W, Regierer, Anne C, Richter, Jutta G, Rieg, Siegbert, Roemmele, Christoph, Ruethrich, Maria M, Schmeiser, Tim, Schulze-Koops, Hendrik, Strangfeld, Anja, Vehreschild, Maria J G T, Voit, Florian, Voll, Reinhard E, Vehreschild, Jörg Janne, Müller-Ladner, Ulf, Pfeil, Alexander
• Format: Article
• Language: English
• Subjects: COVID-19; general population; inflammatory rheumatic diseases; Medicine; severe disease; tumor necrosis factor-alpha inhibitors
• ISSN: 2296-858X; 2296-858X
• DOI: 10.3389/fmed.2024.1332716

To investigate, whether inflammatory rheumatic diseases (IRD) inpatients are at higher risk to develop a severe course of SARS-CoV-2 infections compared to the general population, data from the German COVID-19 registry for IRD patients and data from the Lean European Survey on SARS-CoV-2 (LEOSS) infected patients covering inpatients from the general population with SARS-CoV-2 infections were compared. 4310 (LEOSS registry) and 1139 cases (IRD registry) were collected in general. Data were matched for age and gender. From both registries, 732 matched inpatients (LEOSS registry: = 366 and IRD registry: = 366) were included for analyses in total. Regarding the COVID-19 associated lethality, no significant difference between both registries was observed. Age > 65°years, chronic obstructive pulmonary disease, diabetes mellitus, rheumatoid arthritis, spondyloarthritis and the use of rituximab were associated with more severe courses of COVID-19. Female gender and the use of tumor necrosis factor-alpha inhibitors (TNF-I) were associated with a better outcome of COVID-19. Inflammatory rheumatic diseases (IRD) patients have the same risk factors for severe COVID-19 regarding comorbidities compared to the general population without any immune-mediated disease or immunomodulation. The use of rituximab was associated with an increased risk for severe COVID-19. On the other hand, the use of TNF-I was associated with less severe COVID-19 compared to the general population, which might indicate a protective effect of TNF-I against severe COVID-19 disease.