Infectious Disease

Inflammatory joint illness carries a “low over-risk” of COVID-19 hospitalization and loss of life

March 10, 2021

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Bower does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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In the first few months of the COVID-19 pandemic, the increased all-cause mortality in patients with rheumatoid arthritis and other inflammatory joint diseases largely reflected that of the general population, according to the data.

Meanwhile, the average absolute risks for hospital stays, intensive care units, and deaths from COVID-19 in patients with inflammatory joint disease have been low, albeit higher than in the general population, the researchers wrote. In addition, they found that anti-rheumatic therapy, with the exception of rituximab (Rituxan; Genentech, Biogen) and JAK inhibitors, does not significantly affect the risk of severe COVID-19.

In the early months of the COVID-19 pandemic, the increased all-cause mortality in patients with RA and other inflammatory joint diseases largely mirrored that of the general population, according to the data. Data derived from Bower H, et al. Ann Rheum Dis. 2021; doi: 10.1136 / annrheumdis-2021-219845.

“The SARS-CoV-2 pandemic has concerns about its effects in people with chronic inflammatory joint diseases (IJDs) such as rheumatoid arthritis (RA) with an already higher morbidity and mortality pattern than in the general population and in treatments (disease-modifying anti-inflammatory drugs) on the one hand, associated with an increased risk of serious infections and, on the other hand, having positive effects on severe COVID-19 ”. Hannah Bower, PhD, MSc, of the Karolinska Institute in Stockholm and colleagues wrote in the Annals of the Rheumatic Diseases.

“These concerns have created significant challenges in clinical practice and patient counseling,” they added. “Commendable efforts have been made to answer these questions. Although preliminary evidence is available, interpreting these results is not straightforward. “

To assess the absolute and relative risks for all-cause mortality and severe COVID-19 in patients with inflammatory joint disease, as well as for various anti-inflammatory drugs, Bower and colleagues analyzed data from several national Swedish multi-registry links. Using these registries, the researchers identified 53,455 adults with RA as well as 57,112 adults with other inflammatory joint diseases – spondyloarthropathies, psoriatic arthritis, or juvenile idiopathic arthritis – in March 2020.

Bower and colleagues then compared the annual all-cause mortality from March to September for the years 2015 to 2020 within and between cohorts. In addition, they used Cox regression to estimate the absolute and relative risks for hospital stays, intensive care units, and deaths from COVID-19 for March through September 2020.

According to the researchers, absolute all-cause mortality in patients with RA or other inflammatory joint diseases was higher from March 2020 to September 2020 than from 2015 to 2019. However, the relative risks compared to the general population remained similar.

In particular, from March 2020 to September, unadjusted models showed increased mortality in adults with RA (HR = 1.99; 95% CI, 1.84-2.16) and other inflammatory joint diseases (HR = 1.52; 95% CI , 1.34-1.73) 2020. The HRs for 2020 did not differ from those for 2015-2019, according to the researchers.

In addition, after adjusting for comorbidities and socioeconomic factors, most of the increased mortality was in patients with RA (adjusted HR = 1.18; 95% CI 1.09-1.28) and all of the increased mortality was in patients with other inflammatory joint diseases (adjusted HR =) 0.96; 95% CI, 0.84-1.09) disappeared in 2020.

The risk of hospitalization for COVID-19 from March to September 2020 for all patients with inflammatory joint disease was 0.5%, compared with 0.3% in the general population. The ICU admission risks due to COVID-19 were 0.04% and 0.03%, respectively, while the risks of death due to COVID-19 were 0.1% and 0.07%, respectively.

Anti-inflammatory drugs were not associated with an increased risk of serious COVID-19 outcomes. However, the precision for rituximab and JAK inhibitors was limited, which required further review.

“The increased risk of hospitalization and death from COVID-19 in patients with IJD largely mirrors that of the general population, at least in relative terms,” ​​wrote Bower and colleagues. “In absolute terms, risks and excessive risks are small.”

“[Conventional synthetic] DMARDs, TNF inhibitors, abatacept, and tocilizumab as used in clinical practice seem safe, but signals for rituximab and JAK [inhibitors] need to be checked to see if these are specific to COVID-19 or reflect channeling, ”they added. “In order to show that overall mortality in unselected patients with IJD remains significantly increased compared to the general population even in the absence of COVID-19, our study recalls a still large, unmet need.”

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