TNFi is associated with positive outcome, but JAKi and rituximab are associated with negative outcome of SARS-CoV-2 infection in patients with RMD

Anne Constanze Regierer; Rebecca Hasseli; Martin Schäfer; Bimba F Hoyer; Andreas Krause; Hanns-Martin Lorenz; Alexander Pfeil; Jutta Richter; Tim Schmeiser; Hendrik Schulze-Koops; Anja Strangfeld; Reinhard E Voll; Christof Specker; Ulf Mueller-Ladner

doi:10.1136/rmdopen-2021-001896

TNFi is associated with positive outcome, but JAKi and rituximab are associated with negative outcome of SARS-CoV-2 infection in patients with RMD

RMD Open. 2021 Oct;7(3):e001896. doi: 10.1136/rmdopen-2021-001896.

Authors

Anne Constanze Regierer^#¹, Rebecca Hasseli^#², Martin Schäfer³, Bimba F Hoyer⁴, Andreas Krause⁵, Hanns-Martin Lorenz⁶, Alexander Pfeil⁷, Jutta Richter⁸, Tim Schmeiser⁹, Hendrik Schulze-Koops¹⁰, Anja Strangfeld³, Reinhard E Voll^{11

12}, Christof Specker^{13

14}, Ulf Mueller-Ladner¹⁵

Affiliations

¹ Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany [email protected].
² Department of Rheumatology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany.
³ Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany.
⁴ Department for Rheumatology and Clinical Immunology, University of Schleswig-Holstein at Kiel, Kiel, Germany.
⁵ Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany.
⁶ Medicine V, University of Heidelberg, Heidelberg, Germany.
⁷ IDIR, University of Jena, Jena, Germany.
⁸ Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
⁹ Krankenhaus St. Josef, Wuppertal, Germany.
¹⁰ Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany.
¹¹ Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹² Centre of Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹³ Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany.
¹⁴ Rheumatology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany.
¹⁵ Rheumatology and Clinical Immunology, Giessen University, Bad Nauheim, Germany.

^# Contributed equally.

Abstract

Introduction: Several risk factors for severe COVID-19 specific for patients with inflammatory rheumatic and musculoskeletal diseases (RMDs) have been identified so far. Evidence regarding the influence of different RMD treatments on outcomes of SARS-CoV-2 infection is still poor.

Methods: Data from the German COVID-19-RMD registry collected between 30 March 2020 and 9 April 2021 were analysed. Ordinal outcome of COVID-19 severity was defined: (1) not hospitalised, (2) hospitalised/not invasively ventilated and (3) invasively ventilated/deceased. Independent associations between demographic and disease features and outcome of COVID-19 were estimated by multivariable ordinal logistic regression using proportional odds model.

Results: 2274 patients were included. 83 (3.6%) patients died. Age, male sex, cardiovascular disease, hypertension, chronic lung diseases and chronic kidney disease were independently associated with worse outcome of SARS-CoV-2 infection. Compared with rheumatoid arthritis, patients with psoriatic arthritis showed a better outcome. Disease activity and glucocorticoids were associated with worse outcome. Compared with methotrexate (MTX), TNF inhibitors (TNFi) showed a significant association with better outcome of SARS-CoV-2 infection (OR 0.6, 95% CI0.4 to 0.9). Immunosuppressants (mycophenolate mofetil, azathioprine, cyclophosphamide and ciclosporin) (OR 2.2, 95% CI 1.3 to 3.9), Janus kinase inhibitor (JAKi) (OR 1.8, 95% CI 1.1 to 2.7) and rituximab (OR 5.4, 95% CI 3.3 to 8.8) were independently associated with worse outcome.

Conclusion: General risk factors for severity of COVID-19 play a similar role in patients with RMDs as in the normal population. Influence of disease activity on COVID-19 outcome is of great importance as patients with high disease activity-even without glucocorticoids-have a worse outcome. Patients on TNFi show a better outcome of SARS-CoV-2 infection than patients on MTX. Immunosuppressants, rituximab and JAKi are associated with more severe course.

Keywords: COVID-19; antirheumatic agents; glucocorticoids.

Publication types

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

MeSH terms

COVID-19 Drug Treatment*
Humans
Janus Kinase Inhibitors* / therapeutic use
Rituximab* / therapeutic use
Tumor Necrosis Factor Inhibitors* / therapeutic use

Substances

Janus Kinase Inhibitors
Tumor Necrosis Factor Inhibitors
Rituximab