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Risk of severe COVID-19 in patients with inflammatory rheumatic diseases treated with immunosuppressive therapy in

P M McKeigue1,2, D Porter3, R J Hollick4

  • 1Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

Scandinavian Journal of Rheumatology
|May 13, 2022
PubMed

Insights

Patients with inflammatory rheumatic diseases on immunosuppressive drugs face a higher risk of hospitalized COVID-19. Methotrexate and TNF inhibitors showed lower risks, while prednisolone posed the highest risk, indicating varied drug safety profiles for COVID-19 outcomes.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Pharmacology

Background:

  • Patients with inflammatory rheumatic diseases (IRDs) often require immunosuppressive drugs.
  • The impact of these treatments on severe COVID-19 outcomes is a critical public health concern.

Purpose of the Study:

  • To investigate the association between immunosuppressive drug use in IRD patients and the risk of severe COVID-19.
  • To identify specific immunosuppressive agents associated with increased or decreased COVID-19 hospitalization risk.

Main Methods:

  • A case-control study linked a cohort of 4633 patients on targeted disease-modifying antirheumatic drugs (DMARDs) with COVID-19 cases in Scotland.
  • Rate ratios for hospitalized COVID-19 were calculated comparing DMARD users to the general population.

Main Results:

  • Patients on DMARDs had an elevated risk of hospitalized COVID-19 (rate ratio 2.14 for conventional synthetic DMARDs, 2.01 for TNF inhibitors, 3.83 for other targeted DMARDs).
  • Among conventional synthetic DMARDs, methotrexate was associated with the lowest risk (1.66), while high-dose prednisolone (>10 mg/day) showed the highest risk (5.4).

Conclusions:

  • Immunosuppressive drug treatment in IRD patients is linked to an increased risk of hospitalized COVID-19.
  • Methotrexate, hydroxychloroquine, and TNF inhibitors appear to carry lower risks, whereas prednisolone is associated with the highest risk.
  • Further research is needed to precisely quantify risks for each targeted DMARD class.
Abstract

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