DIFFERENTIAL IMPACT OF TNFI, JAKI AND RITUXIMAB ON THE OUTCOME OF SARS-COV-2 INFECTION IN RMD PATIENTS
Authors: Anne Regierer et al.
In this study from the German COVID19-Rheuma registry the risk factors for the outcome of SARS-CoV-2 infection in patients with rheumatic and musculoskeletal diseases (RMD), specifically focusing on the impact of the treatment, were investigated.
Outcome of SARS-CoV-2 infection severity was defined in three groups: hospitalized, ventilated or deceased. 2,274 patients were included. 83 patients died, resulting in a case fatality rate of 3.6%.
In the ordinal regression analysis, age, male sex, cardiovascular disease, hypertension, chronic lung diseases and chronic kidney disease were independently associated with a worse outcome of SARS-CoV-2 infection. Disease activity and glucocorticoids (GC) were associated with severity of SARS-CoV-2 infection. Compared to patients with RA, patients with PsA had better, patients with vasculitis, SLE and SpA had no significant different outcome.
For the analysis of the impact of RMD treatment, MTX monotherapy was used as reference. TNFi showed a significant association with a better outcome of SARS-CoV-2 infection. In contrast, immunosuppressants (mycophenolate mofetil, azathioprine, cyclophosphamide, ciclosporin), JAKi and rituximab were independently associated with a worse outcome of SARS-CoV-2 infection.
Known general risk factors for severity of SARS-CoV-2 infection such as age, male sex, and certain comorbidities play a similar role in RMD patients. PsA patients have a better outcome of SARS-CoV-2 infection compared to RA. The influence of disease activity is of great importance as patients in high disease activity – even without GCs – have a worse outcome. Regarding RMD treatment, patients on TNFi show a better outcome of SARS-CoV-2 infection than MTX patients. The signals showing a less favorable outcome of SARS-CoV-2 infection for immunosuppressants, rituximab, and JAKi could be reproduced.