Rheumatic Disease, Medication Does Not Raise COVID-19 Risk

Patients with rheumatic diseases do not face heightened risk of serious illness if they contract SARS-CoV-2, even if they are treated with immunosuppressant medications, according to a new abstract presented at the American College of Rheumatology’s annual meeting.

The results are good news for patients, since they suggest patients can continue with their regular therapies without running an increased risk of adverse outcomes.

When the coronavirus disease 2019 (COVID-19) pandemic took hold around the world earlier this year, comorbidities emerged as one of the most troubling risk factors for patients who contracted the disease. However, given the novelty of the virus, little data was immediately available regarding which comorbidities, and with therapies, might put patients at particularly high risk of severe disease or death if they contracted the virus.

In the rheumatology community, one major question mark was the potential impact immunosuppressant therapies might have on COVID-19 risk. Some feared such drugs could leave patients more susceptible to the virus, though some anecdotal evidence suggested it might have the opposite effect.

Co-author Akhil Sood, MD, an internal medicine resident at University of Texas Medical Branch, in Galveston, and colleagues decided to analyze data that has emerged since the outbreak of the pandemic in order to get a better understanding of the real-world situation for patients with rheumatic diseases.

The team searched academic databases for studies between January 1 and June 1 that included patients with rheumatic diseases, finding 8 studies that included a combined total of 6,095 patients. The authors then pulled demographic data as well as therapeutic information for the patients.

Of the more than 6000 patients, just 123 (2%) patients were identified who either had tested positive for SARS-CoV-2 or had symptoms strongly suggesting infection. Among those patients, more than one-quarter (28%) had rheumatoid arthritis, and 7% had psoriatic arthritis.

The majority of the patients (68%) were on biologics, the most common of which were anti-tumor necrosis factor medications (31%). A total of 6% of patients were on Janus kinase inhibitors.

Most patients in the studies who contracted COVID-19 (73%) did not require hospitalization. Of the 32 of patients who did require hospitalization, 13 required ICU admission, and 4 patients died.

Sood said additional research with larger cohorts would be needed to confirm their findings, but he said the news suggests rheumatologists and their patients need not worry about continuing their standard medications.

“Based on our findings, patients with rheumatic diseases on biologic and targeted therapies are not at increased risk of COVID-19 infection,” he told Contagion. “We would recommend these patients to continue their immune therapies.”

A similar study, focused on pediatric patients, also found no excess risk for patients with rheumatic diseases.

Sood noted that other research has been done into whether immunosuppressive cancer therapies might also raise COVID-19 risk, but he said it was important to study rheumatic diseases specifically, since immunosuppressive cancer drugs and rheumatologic medications work differently.

“In patients with cancer, there is overall weakening of the immune system both from the disease as well as the chemotherapy,” he said. “Such immunosuppression can place them at increased risk for infection. In rheumatic disease, there is dysregulation of the immune system. Therapies act as immune modulators. It is difficult to apply the conclusions from our study on rheumatic disease patients to cancer patients.”