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 |
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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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