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23-07-2021 | Adis Journal Club | Article

Rheumatology and Therapy

TNF-α Blockers Showed Prophylactic Effects in Preventing COVID-19 in Patients with Rheumatoid Arthritis and Seronegative Spondyloarthropathies: A Case–Control Study

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Authors: Mansour Salesi, Behrokh Shojaie, Ziba Farajzadegan, Naghmeh Salesi & Erfan Mohammadi

Abstract

Introduction

The interaction between angiotensin-converting enzyme 2 (ACE2) and SARS-CoV-2 is a crucial factor in the viral infections leading to the release of inflammatory proteins, such as TNF-α. Thus, it is hypothesized that TNF-α blockers can prevent either COVID-19 incidence or its serious symptoms. TNF-α blockers are prescribed to treat various autoimmune disorders, including rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA). Therefore, the objective of this work was to examine this hypothesis that TNF-α blockers can prevent COVID-19 incidence in patients with RA or SpA.

Methods

A case–control study was conducted through interviews based on a structured questionnaire to investigate the frequency of COVID-19 incidence in 254 eligible patients with RA or SpA about whom 45% were under treatment with one type of TNF-α blockers including infliximab, adalimumab, and etanercept at least for 3 months during the COVID-19 pandemic. Interviews were carried out twice, at the beginning and the end of the study (June–December 2020). Patients with COVID-19 during the study or before that were considered as cases. The control group was patients without COVID-19 experience. Data were analyzed using descriptive statistics, and logistic regression was used to determine the relationships between COVID-19 incidence and independent variables.

Results

A small percentage of patients treated with TNF-α blockers (5.22%, 6/115) experienced COVID-19, while a large percentage of patients with COVID-19 did not receive TNF-α blockers (27.34%, 38/139). According to odds ratio, adalimumab, infliximab, and etanercept decreased significantly the risk of developing COVID-19 up to 96.8, 95, and 80.3% (p < 0.05), respectively. Therefore, TNF-α blockers could probably decrease the chances of the COVID-19 incidence in patients with RA or SpA.

Conclusions

A direct and positive correlation between the use of TNF-α blockers and a reduction in the incidence of COVID-19 could suggest the prophylactic role of these drugs in preventing COVID-19 in patients with RA and SpA.

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Key Points

Why carry out this study?
The release of inflammatory proteins, such as TNF-α, is a main part of infection with SARS-CoV-2 leading to a cytokine storm (hypercytokinemia).
Assessing the chances of developing COVID-19 in patients receiving TNF-α blockers to treat their autoimmune diseases could provide a valuable research opportunity to test the hypothesis that TNF-α blockers are able to prevent either COVID-19 incidence or its serious symptoms.
What was learned from the study?
TNF-α blockers including adalimumab, infliximab, and etanercept decreased significantly the risk of developing COVID-19 in patients with rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA).
The low incidence of COVID-19 in patients treated with TNF-α blockers compared with the high percentage of COVID-19 in patients who did not receive any TNF-α blockers could confirm the prophylactic role of these drugs in preventing COVID-19 in patients with rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA).