Incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases treated with targeted biologic and synthetic disease-modifying anti-rheumatic drugs

Xabier Michelena; Helena Borrell; Mireia López-Corbeto; María López-Lasanta; Estefanía Moreno; María Pascual-Pastor; Alba Erra; Mayte Serrat; Esther Espartal; Susana Antón; Gustavo Adolfo Añez; Raquel Caparrós-Ruiz; Andrea Pluma; Ernesto Trallero-Araguás; Mireia Barceló-Bru; Miriam Almirall; Juan José De Agustín; Jordi Lladós; Antonio Julià; Sara Marsal

doi:10.1016/j.semarthrit.2020.05.001

Incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases treated with targeted biologic and synthetic disease-modifying anti-rheumatic drugs

Semin Arthritis Rheum. 2020 Aug;50(4):564-570. doi: 10.1016/j.semarthrit.2020.05.001. Epub 2020 May 16.

Authors

Xabier Michelena¹, Helena Borrell², Mireia López-Corbeto³, María López-Lasanta⁴, Estefanía Moreno⁵, María Pascual-Pastor⁶, Alba Erra⁷, Mayte Serrat⁸, Esther Espartal⁹, Susana Antón¹⁰, Gustavo Adolfo Añez¹¹, Raquel Caparrós-Ruiz¹², Andrea Pluma¹³, Ernesto Trallero-Araguás¹⁴, Mireia Barceló-Bru¹⁵, Miriam Almirall¹⁶, Juan José De Agustín¹⁷, Jordi Lladós¹⁸, Antonio Julià¹⁹, Sara Marsal²⁰

Affiliations

¹ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. Electronic address: [email protected].
² Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
³ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
⁴ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
⁵ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
⁶ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
⁷ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
⁸ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
⁹ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹⁰ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹¹ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹² Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹³ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹⁴ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹⁵ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹⁶ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹⁷ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹⁸ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
¹⁹ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].
²⁰ Rheumatology Department, Rheumatology Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona, Spain. Electronic address: [email protected].

Abstract

Objectives: To investigate the incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases receiving targeted biologic and synthetic disease modifying anti-rheumatic drugs (tDMARDs) and to explore the possible effect of these treatments in the clinical expression of COVID-19.

Methods: A cross-sectional study comprising of a telephone survey and electronic health records review was performed including all adult and paediatric patients with rheumatic diseases treated with tDMARDs in a large rheumatology tertiary centre in Barcelona, Spain. Demographics, disease activity, COVID-19 related symptoms and contact history data were obtained from the start of the 2020 pandemic. Cumulative incidence of confirmed cases (SARS-CoV-2 positive PCR test) was compared to the population estimates for the same city districts from a governmental COVID-19 health database. Suspected cases were defined following WHO criteria and compared to those without compatible symptoms.

Results: 959 patients with rheumatic diseases treated with tDMARDs were included. We identified 11 confirmed SARS-CoV-2 positive cases in the adult cohort and no confirmed positive cases in the paediatric cohort. COVID-19 incidence rates of the rheumatic patient cohort were very similar to that of the general population [(0.48% (95% CI 0.09 to 0.87%)] and [0.58% (95% CI 0.56 to 0.60%)], respectively. We found significant differences in tDMARDs proportions between the suspected and non-suspected cases (p=0.002).

Conclusion: Adult and paediatric patients with rheumatic diseases on tDMARDs do not seem to present a higher risk of COVID-19 or a more severe disease outcome when compared to general population.

Keywords: COVID-19; Epidemiology; Pediatric rheumatology; Rheumatic diseases; Targeted disease modifying anti-rheumatic drugs.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Antirheumatic Agents / therapeutic use*
Betacoronavirus / drug effects
Biological Products / therapeutic use*
COVID-19
Case-Control Studies
Child
Child, Preschool
Coronavirus Infections / diagnosis
Coronavirus Infections / epidemiology*
Coronavirus Infections / physiopathology
Cross-Sectional Studies
Female
Humans
Incidence
Infant
Male
Middle Aged
Pandemics
Pneumonia, Viral / diagnosis
Pneumonia, Viral / epidemiology*
Pneumonia, Viral / physiopathology
Retrospective Studies
Rheumatic Diseases / drug therapy*
Rheumatic Diseases / epidemiology
SARS-CoV-2
Spain / epidemiology
Young Adult

Substances

Antirheumatic Agents
Biological Products