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

McKeigue, P. M., Porter, D., Hollick, R. J., Ralston, S. H., McAllister, D. A. and Colhoun, H. M. (2023) Risk of severe COVID-19 in patients with inflammatory rheumatic diseases treated with immunosuppressive therapy in Scotland. Scandinavian Journal of Rheumatology, 52(4), pp. 412-417. (doi: 10.1080/03009742.2022.2063376) (PMID:35549809)

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Abstract

Objective: To investigate the association of severe coronavirus disease 2019 (COVID-19) in patients with inflammatory rheumatic diseases (IRDs) treated with immunosuppressive drugs. Method: A list of 4633 patients on targeted – biological or targeted synthetic – DMARDs in March 2020 was linked to a case–control study that includes all cases of COVID-19 in Scotland. Results: By 22 November 2021, 433 of the 4633 patients treated with targeted DMARDS had been diagnosed with COVID-19, of whom 58 had been hospitalized. With all those in the population not on DMARDs as the reference category, the rate ratio for hospitalized COVID-19 associated with DMARD treatment was 2.14 [95% confidence interval (CI) 2.02–2.26] in those on conventional synthetic (cs) DMARDs, 2.01 (95% CI 1.38–2.91) in those on tumour necrosis factor (TNF) inhibitors as the only targeted agent, and 3.83 (95% CI 2.65–5.56) in those on other targeted DMARDs. Among those on csDMARDs, rate ratios for hospitalized COVID-19 were lowest at 1.66 (95% CI 1.51–1.82) in those on methotrexate and highest at 5.4 (95% CI 4.4–6.7) in those on glucocorticoids at an average dose > 10 mg/day prednisolone equivalent. Conclusion: The risk of hospitalized COVID-19 is elevated in IRD patients treated with immunosuppressive drugs compared with the general population. Of these drugs, methotrexate, hydroxychloroquine, and TNF inhibitors carry the lowest risk. The highest risk is associated with prednisolone. A larger study is needed to estimate reliably the risks associated with each class of targeted DMARD.

Item Type:Articles
Keywords:COVID-19, rheumatic diseases, TNF inhibitors, B cell depletion, glucocorticoids, methotrexate, hydroxychloroquine, sulfasalazine, JAK inhibitors.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McAllister, Professor David and Porter, Dr Duncan
Authors: McKeigue, P. M., Porter, D., Hollick, R. J., Ralston, S. H., McAllister, D. A., and Colhoun, H. M.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Infection & Immunity
Journal Name:Scandinavian Journal of Rheumatology
Publisher:Taylor and Francis
ISSN:0300-9742
ISSN (Online):1502-7732
Published Online:12 May 2022
Copyright Holders:Copyright © 2022 The Author(s)
First Published:First published in Scandinavian Journal of Rheumatology 52(4):412-417
Publisher Policy:Reproduced under a Creative Commons License

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