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 physician registry.

May 31, 2021

Contributor: Jeffrey A Sparks,Zachary S Wallace,Andrea M Seet,Milena A Gianfrancesco,Zara Izadi,Kimme L Hyrich,Anja Strangfeld,Laure Gossec,Loreto Carmona,Elsa F Mateus,Saskia Lawson-Tovey,Laura Trupin,Stephanie Rush,Patricia Katz,Gabriela Schmajuk,Lindsay Jacobsohn,Leanna Wise,Emily L Gilbert,Ali Duarte-García,Maria O Valenzuela-Almada,Guillermo J Pons-Estel,Carolina A Isnardi,Guillermo A Berbotto,Tiffany Y-T Hsu,Kristin M D'Silva,Naomi J Patel,Lianne Kearsley-Fleet,Martin Schäfer,Sandra Lúcia Euzébio Ribeiro,Samar Al Emadi,Liselotte Tidblad,Carlo Alberto Scirè,Bernd Raffeiner,Thierry Thomas,René-Marc Flipo,Jérôme Avouac,Raphaèle Seror,Miguel Bernardes,Maria Margarida Cunha,Rebecca Hasseli,Hendrik Schulze-Koops,Ulf Müller-Ladner,Christof Specker,Viviane Angelina de Souza,Licia Maria Henrique da Mota,Ana Paula Monteiro Gomides,Philippe Dieudé,Elena Nikiphorou,Vanessa L Kronzer,Namrata Singh,Manuel F Ugarte-Gil,Beth Wallace,Akpabio Akpabio,Ranjeny Thomas,Suleman Bhana,Wendy Costello,Rebecca Grainger,Jonathan S Hausmann,Jean W Liew,Emily Sirotich,Paul Sufka,Philip C Robinson,Pedro M Machado,Jinoos Yazdany,

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 physician registry.

To investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA).
We analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders.
Of 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity.
People with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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Jeffrey A Sparks

Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA jsparks@bwh.harvard.edu zswallace@mgh.harvard.edu.

Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.

Zachary S Wallace

Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA jsparks@bwh.harvard.edu zswallace@mgh.harvard.edu.

Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Andrea M Seet

Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

Milena A Gianfrancesco

Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

Zara Izadi

Division of Rheumatology, Department of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.

Kimme L Hyrich

Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.

National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.

Anja Strangfeld

Epidemiology and Health Care Research, German Rheumatism Research Center Berlin, Berlin, Germany.

Laure Gossec

INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France.

APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France.

Loreto Carmona

Instituto de Salud Musculoesqueletica, Madrid, Spain.

Elsa F Mateus

Portuguese League Against Rheumatic Diseases, Lisbon, Portugal.

Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), European League Against Rheumatism, Kilchberg, Switzerland.

Saskia Lawson-Tovey

Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK.

National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.

Laura Trupin

Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

Stephanie Rush

Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

Patricia Katz

Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

Gabriela Schmajuk

Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

San Francisco VA Health Care System, San Francisco, California, USA.

Lindsay Jacobsohn

Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

Leanna Wise

Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA.

Emily L Gilbert

Division of Rheumatology, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA.

Ali Duarte-García

Division of Rheumatology, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota, USA.

Maria O Valenzuela-Almada

Division of Rheumatology, Mayo Clinic Rochester, Rochester, Minnesota, USA.

Guillermo J Pons-Estel

SAR-COVID, Argentina Society of Rheumatology, Buenos Aires, Argentina.

Carolina A Isnardi

SAR-COVID, Argentina Society of Rheumatology, Buenos Aires, Argentina.

Guillermo A Berbotto

Rheumatology, Sanatorio Britanico Rosario, Buenos Aires, Argentina.

Tiffany Y-T Hsu

Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, USA.

Kristin M D’Silva

Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Naomi J Patel

Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Lianne Kearsley-Fleet

Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.

Martin Schäfer

Epidemiology and Health Care Research, German Rheumatism Research Center Berlin, Berlin, Germany.

Sandra Lúcia Euzébio Ribeiro

Hospital Universitário Getúlio Vargas, Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil.

Samar Al Emadi

Rheumatology Department, Hamad Medical Corporation, Doha, Qatar.

Liselotte Tidblad

Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

Carlo Alberto Scirè

Epidemiology Research Unit, Italian Society of Rheumatology, Milano, Italy.

Bernd Raffeiner

Department of Rheumatology, Central Hospital of Bolzano, Padua, Italy.

Thierry Thomas

Société Française de Rhumatologie (SFR), Department of Rheumatology, Hôpital Nord, Universite de Lyon, Lyon, France.

René-Marc Flipo

Department of Rheumatology, University of Lille, Lille, France.

Jérôme Avouac

Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP, Universite de Paris, Paris, France.

Raphaèle Seror

Department of Rheumatology, Assistance Publique, Hopitaux de Paris, Universite Paris-Saclay, Saint-Aubin, France.

Miguel Bernardes

Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.

Rheumatology Department, Centro Hospitalar de Sao Joao EPE, Porto, Portugal.

Maria Margarida Cunha

Rheumatology Department, Garcia de Orta Hospital, Almada, Portugal.

Rebecca Hasseli

Division of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig Universitat Giessen, Giessen, Germany.

Hendrik Schulze-Koops

Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany.

Ulf Müller-Ladner

Division of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig Universitat Giessen, Giessen, Germany.

Christof Specker

Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany.

Viviane Angelina de Souza

Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.

Licia Maria Henrique da Mota

Hospital Universitário de Brasilia, Universidade de Brasilia, Brasilia, Federal District, Brazil.

Ana Paula Monteiro Gomides

Centro Universitario de Brasilia, Brasilia, Federal District, Brazil.

Philippe Dieudé

Rheumatology Department, Bichat-Claude Bernard Hospital, Paris University, Paris, France.

Elena Nikiphorou

Centre for Rheumatic Diseases, King’s College Hospital, King’s College London, London, UK.

Vanessa L Kronzer

Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.

Namrata Singh

Division of Rheumatology, University of Washington, Seattle, Washington, USA.

Manuel F Ugarte-Gil

School of Medicine, Universidad Cientifica del Sur, Lima, Peru.

Rheumatology Department, Level IV Hospital Guillermo Almenara Irigoyen, La Victoria, Peru.

Beth Wallace

Department of Internal Medicine/Rheumatology, University of Michigan, Ann Arbor, Michigan, USA.

VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.

Akpabio Akpabio

Rheumatology Department, Royal Hallamshire Hospital, Sheffield, UK.

Ranjeny Thomas

UQ Diamantina Institute, The University of Queensland, Saint Lucia, Queensland, Australia.

Suleman Bhana

Crystal Run Healthcare, Middletown, New York, USA.

Wendy Costello

Irish Children’s Arthritis Network (iCan), Tipperary, Ireland.

Rebecca Grainger

Department of Medicine, University of Otago, Dunedin, New Zealand.

Jonathan S Hausmann

Program in Rheumatology, Boston Children’s Hospital, Boston, Massachusetts, USA.

Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Jean W Liew

Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.

Emily Sirotich

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada.

Paul Sufka

HealthPartners, St. Paul, Minnesota, USA.

Philip C Robinson

Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.

Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital Health Service District, Herston, Queensland, Australia.

Pedro M Machado

Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.

National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.

Jinoos Yazdany

Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.

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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 physician registry.

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