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Yazdany J. What have registers taught us? Presented at: Biologic Therapies Summit IX; 21.-23. May 2021 (virtual meeting).
Disclosure:
Yazdany does not report any relevant financial information.
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While certain rheumatological drugs are associated with increased hospital stays in COVID-19, people with rheumatological diseases largely achieve results that are comparable to those of the general population, according to a speaker at the Biologic Therapies Summit.
Jinoos Yazdany, MD, MPH, The Vice Chairperson for Real Data Infrastructure, Registration and IRB / Ethics for the Global Rheumatology Alliance dealt with three main questions in her presentation. One was whether patients on immunosuppressants were more prone to initial SARS-CoV-2 infection; The second concerned the results of the infection in patients treated with these drugs. and the third looked at outcomes associated with specific immunosuppressive therapies.
“Patients should be followed up and cared for during the pandemic,” said Dr. Jinoos Yazdany, MPH, to the participants. “Uncontrolled diseases are a risk factor for poor treatment for COVID-19.” Source: Adobe Stock
“When we think back to the early days of the pandemic, we have all wondered what the risk factors are [for rheumatic disease patients],” She said.
Before research into this patient population came about, a number of risk factors emerged for the general population, including cardiovascular disease, high blood pressure, diabetes, chronic lung disease, cancer, kidney disease, and obesity. “Of course, age was by far the biggest risk factor,” added Yazdany.
Jinoos Yazdany
In doing so, she checked some of the data that has since emerged for the rheumatological population.
Early results for 955 patients in Italy showed comparable COVID-19 incidence rates in rheumatoid patients and the general population. “These were very comforting data at the start of the pandemic,” said Yazdany.
Data for more than 1,000 patients from Hong Kong showed that only five people in the study population had a rheumatic or autoimmune disease. “Again, the rate was similar to the general population,” said Yazdany.
Early data for patients treated with immunosuppressive drugs for inflammatory bowel disease in the United States showed a similar trend, according to Yazdany.
“There’s a caveat here, and that is, people who are immunocompromised may be more likely to follow precautions for COVID-19,” Yazdany said. “However, based on these data, they do not have an increased risk of initial infection.”
Regarding the second question, Yazdany referred to results from around 17 million people in the UK at the start of the pandemic. The study looked at the primary outcome of in-hospital mortality.
“Again, age was the top risk factor for poor outcomes,” Yazdany said, noting that comorbidities ranging from obesity to poverty are also linked to mortality.
While rheumatoid arthritis, lupus, and psoriasis had a slightly higher risk of mortality, Yazdany noted that the risk was not as high as that reported for hematologic malignancies and the other comorbidities mentioned above.
In relation to data from the United States, a study in a New York hospital showed that hospital stays for rheumatology patients and non-rheumatology patients were comparable. However, a study at Harvard showed an increased risk of hospitalization and ICU admission for people with rheumatic and autoimmune diseases. “It was interesting that these risks were mitigated after adding other comorbidities to the analysis,” said Yazdany.
Registration data from Denmark and Sweden gave “remarkably similar” results, with the risk of hospitalization in rheumatology being slightly higher compared to the general population. However, Yazdany found that the curves separate with age.
“What do all these studies tell us?” She said. “It is clear that the risk of [poorer outcomes] is really tied to age and comorbidities. “
While the risk of hospitalization is indeed higher in patients with rheumatic and autoimmune diseases, Yazdany believes that the aggregate of these data is “relatively reassuring”.
The American College of Rheumatology and EULAR agree on this point. “ACR and EULAR guidelines state that immunosuppressive drugs should continue,” said Yazdany.
Regarding the final question about certain immunosuppressive drugs, Yazdany suggested that the Global Rheumatology Alliance registry be an important resource for clinicians to understand the risks associated with drugs used by patients.
Early data showed that a dose of prednisone greater than 10 mg per day was associated with an increased risk of hospital stays, while users of TNF inhibitors had fewer hospital stays.
Slightly higher mortality risks have been associated with a number of drugs in the rheumatology armamentarium, including sulfasalazine, mycophenolate mofetil (MMF; CellCept, Genentech), tacrolimus, azathioprine, and cyclophosphamide. “The drug with the highest risk of mortality is rituximab [Rituxan, Genentech]”Said Yazdany.” And again there is a signal for steroids.
Even so, Yazdany emphasized the need to keep patients treated. “It’s important to control disease activity,” she said. “Patients should follow up and care for them during the pandemic. Uncontrolled diseases are a risk factor for poor treatment for COVID-19. “
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