ASSOCIATIONS OF BASELINE USE OF BIOLOGIC OR TARGETED SYNTHETIC DMARDS WITH COVID-19 SEVERITY IN RHEUMATOID ARTHRITIS: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE
Authors: J. Sparks et al.
This large epidemiologic study of patients with rheumatoid arthritis (RA) in the ‘COVID-19 Global Rheumatology Alliance physician registry’ investigated associations of biologic or targeted synthetic (b/ts) DMARDs with severe COVID-19 outcomes. Of the 1,673 patients with RA 498 (34.3%) were hospitalized and 112 (6.7%) died. After adjusting for known confounding factors, rituximab (RTX) was strongly associated with greater odds of having a worse outcome compared to anti-TNFs (TNFi) (OR 3.8, 95% CI: 2.5–5.9). Among RTX users, 42 (18.8%) died compared to 27 (3.3%) of TNFi users. JAK-inhibitors were also associated with greater risk of severe COVID-19 (OR 1.52, 95%CI: 1.02–2.28), while no significant difference in risk of severe evolutions of COVID-19 were seen with the other bDMARDs.
This study underscores again the relative increased risk of specific second line DMARDs in the COVID-19 epidemic. Use of RTX, but for the first time also JAKi, were associated with more severe courses of COVID-19 compared to TNFi use. While the finding for JAKi needs to be replicated in different settings, rheumatologists should currently use RTX with caution and only after full vaccination.