COVID-19 infection rates low in people with rheumatic diseases, most report mild illness

November 06, 2020

ATLANTA -- A new study shows that the COVID-19 infection incidence has been low in people with rheumatic diseases, and most of those infected experience a mild course of illness. Additionally, fatalities have been low among rheumatic disease patients infected with COVID-19. Details of this research was presented at ACR Convergence, the American College of Rheumatology's annual meeting (ABSTRACT #0008).

COVID-19 is the infectious disease caused by the novel coronavirus SARS-CoV-2. As the COVID-19 pandemic surged worldwide in early 2020, the risk of serious infection, complications or fatality was unknown for people with rheumatic disease. Many patients with rheumatic disease are treated with immunosuppressant medications that leave them more susceptible to infection.

As the pandemic began, it was unclear how people with rheumatic diseases, on immunosuppressant therapy, were affected by a COVID-19 infection. Some early studies even suggested that these drugs could have a protective effect, but concerns remained about the vulnerability of this patient population. To learn more, researchers conducted a systematic review of studies that reported outcomes of COVID-19 infection among patients with rheumatic diseases who were taking biologic and targeted therapies.

"When the pandemic started, there was concern on whether to continue or hold immune therapies among patients with rheumatic diseases because they are at increased risk for infection," says the study's co-author, Akhil Sood, MD, an internal medicine resident in rheumatology at the University of Texas Medical Branch in Galveston. "We were interested to see if these patients are at an increased risk for COVID-19 infection. If they were to become infected, we wanted to know the severity of their clinical course. This can help us to determine whether it is safe to continue or hold immune therapies in setting of COVID-19 infection."

The researchers systematically searched PubMed/Medline and Scopus to identify relevant studies from January to June 2020 that reported the outcomes of COVID-19 among patients with rheumatic disease. They extracted demographic information and patients' use of biologics or targeted therapy with Janus kinase (JAK) inhibitors. They measured the following COVID-19 outcomes: hospitalization, admission to an ICU and death. Based on their clinical symptoms, patients were split into two groups: severe, or having increased risk of respiratory failure or life-threatening complications or non-severe.

The final review included 6,095 patients with rheumatic diseases from eight observational cohort studies, with 28% having rheumatoid arthritis (RA) and 7% having psoriatic arthritis (PsA). Of the 6,095 patients, only 123 or 2% were positive or highly suspicious for COVID-19. Across all the studies used for the review, 68% of COVID-19 patients were taking biologics, with 31% taking anti-TNF drugs and 6% taking JAK inhibitors. Among those patients who were infected with the coronavirus, 91 or 73% were never hospitalized. Thirteen patients who were hospitalized required admission to an ICU and four patients died.

"In our analysis, there was a small number of patients on biologic and targeted therapies to make definite conclusions on whether to continue or hold therapies," says Dr. Sood. "We are waiting for additional extensive studies that include more patients with rheumatic disease on biologic and targeted therapies. Another area of interest for us is examining risk factors for severe COVID-19 infection in patients with rheumatic disease. We hope this can help us identify which patients to closely monitor and possibly develop precautions to mitigate their risk."
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About ACR Convergence

ACR Convergence, the ACR's annual meeting, is where rheumatology meets to collaborate, celebrate, congregate, and learn. Join ACR for an all-encompassing experience designed for the entire rheumatology community. ACR Convergence is not just another meeting - it's where inspiration and opportunity unite to create an unmatched educational experience. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official hashtag (#ACR20).

About the American College of Rheumatology

The American College of Rheumatology (ACR) is an international medical society representing over 7,700 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.

ABSTRACT:

COVID-19 Infection Among Patients with Rheumatic Disease on Biologic & Targeted Therapies: A Systematic Review

Background/Purpose:

Information about the outcomes of patients with rheumatic disease with SARS-CoV-2 infection is scarce. Patients with rheumatic disease on immunosuppressive medications might represent a population at increased risk of SARS-CoV-2 infection or serious infection. Interestingly, few studies have suggested protective role of these drugs for COVID-19. We thus conducted a systematic review of studies reporting outcome of COVID-19 infection among patients with rheumatic diseases on biologic & targeted therapies.

Methods:

We systematically searched PubMed/Medline and Scopus from January 1, 2020 to June 1, 2020 to identify studies that reported outcome of COVID-19 among patients with rheumatic disease. Demographic information, use of biologic (anti-TNF, IL-1, IL-6, IL-17, IL-12/IL-23, B cell, or T cell) or targeted therapy (Janus kinase inhibitor) were extracted from studies. The outcome measured was hospitalization, ICU admission, and death. Based on the clinical symptoms and need for hospitalization and ICU care, patients were grouped into severe (increased risk of respiratory failure or life-threatening complications) or non-severe.

Results:

Our systematic review included eight observational cohort studies which comprised of 6095 patients with rheumatic disease. Of these, 123 patients (2%) were positive or highly suspicious for COVID-19 infection based on clinical features. The most common rheumatic diseases were rheumatoid arthritis (28%) and psoriatic arthritis (7%). The proportion of COVID-19 patients on biologics across all studies was 68%. The most common biologic agent was anti-TNF agents (31%). The percentage of users of JAK inhibitors was 6%. Among those with SARS-COV2 infection, 91 patients (73%) were not hospitalized. Among those hospitalized, 13 patients (11% of total) required ICU admission and 4 patients died (3.2% of total).

Conclusions:

In this systematic review, the incidence of COVID-19 infection was low in patients with rheumatic disease. The majority had a mild clinical course and case fatality was low. However, larger cohort studies are necessary to examine outcomes of COVID-19 among biologic and non-biologic users. Furthermore, factors such as disease severity index and duration of biologic & targeted therapy use need to be considered in future studies.

American College of Rheumatology

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