Risk and Severity of COVID-19 in Patients With Rheumatic Disorders Receiving DMARDs vs Methotrexate

doctors with mask caring for patient with mask in hospital, COVID19
Study authors examined the risk for admission and respiratory failure in patients with rheumatic disorders with COVID-19 receiving DMARDs or methotrexate.

Patients with coronavirus disease 2019 (COVID-19) with rheumatic disorders receiving biologic disease-modifying antirheumatic drugs (bDMARDs) are at a greater risk for hospitalization, according to findings published in a research letter in Annals of the Rheumatic Diseases.

Previous studies have shown that patients with inflammatory rheumatic disorders vs the general population are an increased risk for infections. The objective of the current study was to determine the risk for hospitalization and respiratory failure among patients with COVID-19 with rheumatic disorders receiving targeted synthetic DMARDs (tsDMARDs) or bDMARDs vs matched comparators and methotrexate users in Iceland.

The study sample included 1438 patients from ICEBIO, a nationwide registry of patients with inflammatory arthritis receiving tsDMARDs or bDMARDs. In addition, 1746 patients receiving methotrexate were included in the study. Participants from the ICEBIO and methotrexate groups were randomly matched with up to 10 control participants, based on age, sex, and geographic location. Overall, the current analysis included 13,418 ICEBIO comparators and 22,962 methotrexate comparators.

Of the study population, 9 (0.6%) participants from the ICEBIO group, 84 (0.6%) ICEBIO comparators, 5 (0.3%) patients receiving methotrexate, and 134 (0.6%) methotrexate comparators tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). All patients who tested SARS-CoV-2-positive from the ICEBIO group had received tumor necrosis factor inhibitors.

Risk for hospitalization was 9-fold greater for patients from the ICEBIO group (relative risk, 9.33; 95% CI, 2.20-39.6; P <.001), with a 6-fold greater risk to be admitted with hypoxia (relative risk, 6.22; 95% CI, 1.19-32.46; P =.02).

A total of 2 of 3 hospitalized patients from the ICEBIO group, 3 of 3 ICEBIO comparators, 1 from the methotrexate group, and 10 of 13 hospitalized methotrexate comparators received oxygen supplementation.

Mean length of hospital stay was 4.7 days for patients from the ICEBIO group compared with 20.2 days for the ICEBIO comparators, but the difference was not statistically significant (P =.16). None of the patients with rheumatic disorders in any group required mechanical ventilation.

“Further studies in larger populations are needed to better quantify the risk and severity of COVID-19 in patients with rheumatic disorders treated with bDMARDs,” the study authors concluded.


Bjornsson AH, Grondal G, Kristjansson M, Jonsdottir T, Love TJ, Gudbjornsson B; ICEBIO. Prevalence, admission rates and hypoxia due to COVID-19 in patients with rheumatic disorders treated with targeted synthetic or biologic disease modifying antirheumatic drugs or methotrexate: a nationwide study from Iceland. Letter. Ann Rheum Dis. Published online January 5, 2021. doi:10.1136/annrheumdis-2020-219564