The vast majority of patients with rheumatic and musculoskeletal diseases who contract COVID- 19 recover from the virus, regardlessof which medication they receive for theirrheumatic condition, new internationalresearch suggests.
“These results provide, for the first
time, information about the outcome of
COVID- 19 in patients with rheumatic and
musculoskeletal diseases,” said study
investigator Prof. Pedro Machado, of
University College London. “They should
provide some reassurance to patients and
Prof. Machado and his colleagues
looked at 600 COVID- 19 patients from 40
countries and found that those taking TNF
inhibitors for their rheumatic disease were
less likely to be hospitalised for COVID- 19.
However, treatment with more than 10 mg
of prednisone daily – considered a moder-
ate to high dose – was associated with a
higher probability of hospitalisation.
In addition, hospitalisation was notassociated with biologics; JAK inhibitors; conventional disease-modifyingantirheumatic drugs (DMARDs), suchas methotrexate; antimalarials, such ashydroxychloroquine; or NSAIDs – eitheralone or in combination with other biologics, such as TNF inhibitors.
The findings were presented at the congress and were published online in Annalsof the Rheumatic Diseases.
“Initially, there was a huge concern thatthese drugs could affect the outcome ofpatients getting COVID- 19, but what this isshowing is that probably these drugs do notincrease their risk of severe outcome,” Prof.Machado, who is chair of the EULAR Standing Committee on Epidemiology and HealthServices Research, said in an interview.
As of 1 June, 1,061 patients from 28 participating countries had been entered intothe EULAR COVID- 19 database, which waslaunched as part of the international GlobalRheumatology Alliance registry. Patient dataare categorised by factors such as top rheumatology diagnosis, comorbidities, top-fiveCOVID- 19 symptoms, and DMARD therapy atthe time of virus infection.
Prof. Machado’s team combined data
from the EULAR and Global Rheumatol-
ogy Alliance COVID- 19 registries from 24
March to 20 April. They looked at patientfactors – such as age, sex, smoking status, rheumatic diagnosis, comorbidities,and rheumatic therapies – to examine theassociation of rheumatic therapies withhospitalisation rates and COVID- 19 diseasecourse.
Of the 277 patients (46%) in the studycohort who required hospitalisation, 55(9%) died. But this finding shouldn’t beviewed as the true rate of hospitalisation or death in patients with rheumaticdisease and COVID- 19, said Prof. GerdBurmester of Charité–University MedicineBerlin.
“There’s tremendous bias in terms of
more serious cases of COVID- 19 being
reported to the registries,” he explained,
“because the mild cases won’t even show
up at their rheumatologist’s office.”
“This can skew the idea that COVID- 19
is much more dangerous to rheumatic pa-
tients than to the regular population,” Prof.
Burmester said in an interview. “It scares
the patients, obviously, but we believe this
The study can only highlight associ-
ations between rheumatic drugs and
COVID- 19 outcomes. “We cannot say there
is a causal relationship between the find-
ings,” Prof. Machado said.
Longer-term data, when available,should illuminate “more granular” aspectsof COVID- 19 outcomes in rheumatic patients, including their risks of requiringventilation or developing a cytokine storm,he noted.
Prof. Burmester and Prof. Machadoagree that research needs to continue asthe pandemic rages on. But so far, “thereare no data suggesting that, if you’re ona targeted, dedicated immunomodulator,your risk is higher to have a worse courseof COVID- 19 than the general population,”Prof. Burmester said.
“We simply didn’t know that when thepandemic started, and some patients evendiscontinued their drugs out of this fear,”he added. “It’s more reassuring than weoriginally thought.”
Most rheumatology drugs don’t increase
COVID- 19 hospitalisation risk
PROF. MACHADO PROF. BURMESTER