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

Annals of the Rheumatic Diseases - Tập 80 Số 9 - Trang 1137-1146 - 2021
Jeffrey A. Sparks1, Zachary S. Wallace2,3, Andrea M. Seet4, Milena Gianfrancesco4, Zara Izadi5, Kimme L Hyrich6,7, Anja Strangfeld8, Laure Gossec9,10, Loreto Carmona11, Elsa F Mateus12,13, Saskia Lawson‐Tovey14,15, Laura Trupin4, Stephanie Rush4, Patricia Katz4, Gabriela Schmajuk4,16, Lindsay Jacobsohn4, Leanna Wise17, Emily L. Gilbert18, Alí Duarte‐García19, Maria O. Valenzuela‐Almada20, Guillermo J. Pons‐Estel21, C. A. Isnardi21, Guillermo Berbotto22, Tiffany Hsu23, Kristin M. D’Silva2, Naomi J. Patel2, Lianne Kearsley‐Fleet6, Martin Schäfer8, Sandra Lúcia Euzébio Ribeiro24, Samar Al Emadi25, Liselotte Tidblad26, Carlo Alberto Scirè27, Nicolas Roux28, María José Santos29, R.M. Flipo30, Jérôme Avouac31, Raphaèle Séror32, Miguel Bernardes33,34, Maria Margarida Cunha35, Rebecca Hasseli36, Hendrik Schulze‐Koops37, Ulf Müller‐Ladner36, Christof Specker38, Viviane Angelina de Souza39, Lícia Maria Henrique da Mota40, N. De la Torre Rubio41, Philippe Dieudé42, Elena Nikiphorou43, Vanessa L. Kronzer44, Namrata Singh45, Manuel F. Ugarte‐Gil46,47, Beth I. Wallace48,49, Akpabio Akpabio50, Ranjeny Thomas51, Suleman Bhana52, Wendy Costello53, Rebecca Grainger54, Jonathan S. Hausmann55,56, Jean W. Liew57, Emily Sirotich58,59, Paul Sufka60, Philip C. Robinson61,62, Pedro Machado63,64, Jinoos Yazdany4
1Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
2Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
3Department of Medicine, Harvard Medical School, Boston, Massachusetts USA
4Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
5Division of Rheumatology, Department of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
6Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
7National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
8Epidemiology and Health Care Research, German Rheumatism Research Center Berlin, Berlin, Germany
9APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
10INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
11Instituto de Salud Musculoesqueletica, Madrid, Spain
12Portuguese League Against Rheumatic Diseases, Lisbon, Portugal
13Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), European League Against Rheumatism, Kilchberg, Switzerland
14Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
15National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
16San Francisco VA Health Care System, San Francisco, California, USA
17Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA
18Division of Rheumatology, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
19Division of Rheumatology, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota, USA
20Division of Rheumatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
21SAR-COVID, Argentina Society of Rheumatology, Buenos Aires, Argentina
22Rheumatology, Sanatorio Britanico Rosario, Buenos Aires, Argentina
23Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
24Hospital Universitário Getúlio Vargas, Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil
25Rheumatology Department, Hamad Medical Corporation, Doha, Qatar
26Division of clinical epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
27Epidemiology Research Unit, Italian Society of Rheumatology, Milano, Italy
28Department of Rheumatology, Central Hospital of Bolzano, Padua, Italy
29Société Française de Rhumatologie (SFR), Department of Rheumatology, Hôpital Nord, Universite de Lyon, Lyon, France
30Department of Rheumatology, University of Lille, Lille, France
31Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP, Universite de Paris, Paris, France
32Department of Rheumatology, Assistance Publique, Hopitaux de Paris, Universite Paris-Saclay, Saint-Aubin, France
33Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
34Rheumatology Department, Centro Hospitalar de Sao Joao EPE, Porto, Portugal
35Rheumatology Department, Garcia de Orta Hospital, Almada, Portugal
36Division of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig Universitat Giessen, Giessen, Germany
37Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
38Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
39Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
40Hospital Universitário de Brasilia, Universidade de Brasilia, Brasilia, Federal District, Brazil
41Centro Universitario de Brasilia, Brasilia, Federal District, Brazil
42Rheumatology Department, Bichat-Claude Bernard Hospital, Paris University, Paris, France
43Centre for Rheumatic Diseases, King's College Hospital, King's College London, London, UK
44Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
45Division of Rheumatology University of Washington, Seattle, Washington, USA
46Rheumatology Department, Level IV Hospital Guillermo Almenara Irigoyen, La Victoria, Peru
47School of Medicine, Universidad Cientifica del Sur, Lima, Peru
48Department of Internal Medicine/Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
49VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
50Rheumatology Department, Royal Hallamshire Hospital, Sheffield, UK
51UQ Diamantina Institute, The University of Queensland, Saint Lucia, Queensland, Australia
52Crystal Run Healthcare, Middletown, New York, USA
53Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
54Department of Medicine, University of Otago, Dunedin, New Zealand
55Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
56Program in Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
57Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
58Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
59Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
60Healthpartners, St Paul, Minnesota, USA
61Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
62Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital Health Service District, Herston, Queensland, Australia
63Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK
64National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK

Tóm tắt

ObjectiveTo investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA).MethodsWe 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.ResultsOf 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.ConclusionsPeople 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.

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Annals of the Rheumatic Diseases

Tập 80 Số 9

1137-1146

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