The incidence and severity of coronavirus disease 2019 (COVID-19) in patients with rheumatic disease receiving disease-modifying antirheumatic drugs (DMARDs) vs the general population is not significantly different, according to study results published in Arthritis and Rheumatology.

Patients at 2 rheumatology centers in Lombardy, Italy were invited to participate in a survey for the study between February 25t and April 10, 2020. All patients with rheumatic disease were being treated with targeted synthetic or biologic DMARDs (ts/bDMARDs). The survey included data on contact with individuals infected with COVID-19, viral symptoms, and changes in behavior, or disease management; COVID-19 was confirmed by a nasopharyngeal swab.

A total of 955 patients (67.4% women; mean age, 53.7±14 years) with rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, and other autoinflammatory diseases, were included in the study, with a survey responder rate of 98.05%. A majority of patients were receiving anti-tumor necrosis factor (TNF) therapy (55.8%), with nearly half the patient cohort (47.3%) receiving a bDMARD as monotherapy. A total of 47.3% of patients had ≥1 comorbidity, mostly high blood pressure.

The survey indicated that 90.6% of patients took precautionary measures to prevent infection with COVID-19; 93.2% of patients maintained their ts/bDMARD treatment regimen, and rheumatic disease activity remained stable in 89.5%. In total, 6 patients with rheumatic diseases tested positive for COVID-19, 5 of whom were treated with anti-TNF agents; 2 patients were receiving bDMARDs as monotherapy.


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Researchers observed that the COVID-19 infection rate of patients with rheumatic disease did not differ from the general population (0.62% vs 0.66%; P =.92). While half the number of infected patients (n=3) were admitted to the hospital for oxygen supplementation, none were admitted to the intensive care unit. All patients who tested positive for COVID-19 temporarily discontinued receiving ts/bDMARD therapy during viral infection. An additional 144 patients developed respiratory symptoms; however, they had no access to nasopharyngeal swabs. Of these patients who suspected to have COVID-19, 33 temporarily suspended receiving biologic therapy for an average of 16.9 days, with 9 patients reporting a disease relapse.

A limitation of this study was the cross-sectional survey design. Patients were interviewed by telephone, and it was possible that some symptoms were missed or that nonresponsive patients (n=24) were infected. Furthermore, tests for COVID-19 were unavailable for many patients who were experiencing respiratory symptoms.

Researchers concluded “[The] results highlight the attitude [of patients with] rheumatic [disease] to prevent the contagion while maintaining their chronic treatments. The incidence and severity of COVID-19 in patients treated with ts/bDMARDs was not significantly different from that of the general population in the same region.”

Reference

Favalli EG, Monti S, Ingegnoli F, Balduzzi S, Caporali R, Montecucco C. Incidence of COVID-19 in patients with rheumatic diseases treated with targeted immunosuppressive drugs: what can we learn from observational data? [published online June 7, 2020] Arthritis Rheum. doi:10.1002/ART.41388