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ACR 2020 | Daily Highlights
DMARDs in COVID-19 patients
ANTIRHEUMATIC DISEASE THERAPIES IN PATIENTS WITH COVID-19: A SYSTEMATIC REVIEW AND META-ANALYSIS
Abstract: 0010
Authors: Michael Putmanet al.
Key content:
Antirheumatic disease therapies have been used to treat coronavirus disease 2019 (COVID-19) and its complications. There has been particular interest in the antimalarial agent hydroxychloroquine (HCQ) and in agents that inhibit interleukin-1 (IL1) or interleukin-6 (IL-6). In this systematic review and meta-analysis the current evidence for antirheumatic therapies in the treatment of COVID-19 was analyzed.
The authors identified 3,935 articles, of which 275 were included for full text review. After full text exclusion, 45 studies were included in qualitative review (4 randomized controlled trials, 29 cohort studies, and 12 case series) and six studies were included in meta-analyses (4 cohort studies of HCQ, 2 cohort studies of anakinra).
In this systematic review and meta-analysis, hydroxychloroquine use was not associated with benefit or harm in terms of COVID-19 mortality. The IL-1 inhibitor anakinra was associated with lower mortality, but this should be interpreted with caution given substantial risks of bias. A meta-analysis could not be performed on interleukin-6 inhibitor studies, which were frequently conflicting and had some/high risk of bias. Studies that assessed glucocorticoids, intravenous immunoglobulin, and baricitinib also had conflicting results and the majority had a high risk of bias.
Relevance:
This meta-analysis showed that hydroxychloroquine has no benefit in the treatment of COVID-19, whereas anakinra, an interleukin-1 inhibitor, has some benefit with regard to lower mortality. Because of study biases there is not enough evidence at the moment for other possible treatment modalities like Interleukin-6 and TNF-alpha inhibitors, intravenous immunoglobulins or JAK inhibition.
In the meantime, a RCT for Tocilizumab was published in the NEJM of October 21st. Tocilizumab was not effective for preventing intubation or death in moderately ill hospitalized patients with Covid-19.
More RCT trials of different possible beneficial antirheumatic therapies for COVID-19 are under way and urgently needed. In my opinion besides dexamethasone, interleukin-1, TNF-alpha and JAK inhibition have the greatest potential for positive outcomes.
Zusammenfassung und Kommentar von:
Dr. Thomas Langenegger
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