Patients with rheumatoid arthritis (RA) continue to face a higher likelihood of experiencing adverse outcomes due to COVID-19 compared with the broader population, according to study results published in Rheumatology. This risk is particularly heightened among individuals receiving rituximab, which should be reserved as a last resort treatment strategy for those with COVID-19.
Investigators assessed COVID-19-related outcomes among patients with RA following the second year of the pandemic to determine if these patients remain at greater risk for COVID-19-related hospitalization and mortality.
A retrospective, observational, population-based cohort study was conducted in Greece, including all adult patients diagnosed with RA who were still living as of January 1st, 2022. Each patient had obtained a minimum of 1 prescription for corticosteroids, conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), immunosuppressants, biologic DMARDs, or targeted synthetic DMARDs between January 1st, 2015, and December 31st, 2019.
Data were taken from the Greek nationwide electronic prescription database and national COVID-19 digital registries.
Patients with RA were matched 1:5, based on age, sex, and residential region, with individuals from the general population. Confirmed cases of COVID-19 infections, instances of hospitalizations and mortality, previous encounters with COVID-19, vaccination history, and administration of antiviral medications were documented.
A total of 34,182 patients with RA were included in the analysis. Between January 1st, 2022, and June 30th, 2022, instances of COVID-19-related infections (16.29% vs 13.88%), hospitalizations (1.43% vs 0.72%), and mortality (0.31% vs 0.17%) occurred more frequently among patients with RA compared with the general population, respectively.
Incidence rate ratios (IRRs) per 1000 person-years of infection (IRR, 1.19), hospitalization (IRR, 2.0), and mortality (IRR, 1.81) were increased among patients with RA, despite their having higher vaccination rates (88.89%) compared with the general population (84.07%). Patients with RA were also reported to more frequently use antiviral medications vs the general population (0.67% vs. 0.23%).
Following adjustments for age, sex, vaccinations, previous COVID-19 encounters, and medication use, logistic regression analysis revealed that patients with RA were at increased risk for hospitalization (odds ratio [OR], 2.02; 95% CI, 1.79-2.27) and mortality (OR, 1.73; 95% CI, 1.36-2.20).
Within the subset of patients with RA infected with SARS-CoV-2, treatment with rituximab was associated with an increased risk for hospitalization (OR, 6.12; 95% CI, 2.89-12.92) and mortality (OR, 12.06; 95% CI, 3.90-37.31). Treatment with Janus kinase inhibitors was also associated with increased risk for hospitalization (OR, 2.18; 95% CI, 1.56-3.06).
Among study limitations, investigators were unable to account for disease activity or certain comorbidities that may have influenced adverse outcomes. Additionally, analysis was not adjusted for body mass index, glucocorticoid dose, or socioeconomic variables. Finally, patients who obtained medications over the counter may have been inadvertently excluded from the study.
The study authors concluded, “Rheumatologists and RA patients should continue to remain alert and follow all the prophylactic measures, including vaccinations and antiviral treatment against SARS-CoV2.”
Bournia V-K, Fragoulis GE, Mitrou P, et al. Outcomes of covid-19 omicron variant in patients with rheumatoid arthritis: a nationwide Greek Cohort Study. Rheumatology (Oxford). Published online July 19, 2023. doi:10.1093/rheumatology/kead354