medwireNews: In patients with chronic inflammatory arthritis, biologics and Janus kinase (JAK) inhibitors are associated with a reduced risk for confirmed or highly suspected COVID-19, but glucocorticoids are associated with an increased risk, according to a survey of patients in Northern Italy.
The study participants consisted of 2050 patients with rheumatoid arthritis, undifferentiated arthritis, psoriatic arthritis, or spondyloarthritis, who attended an arthritis outpatient clinic at one of two hospitals in Northern Italy and completed the survey in person or over the phone between February and April 2020.
The majority (66%) of patients were female, with a mean age of 58 years and a median disease duration of 10 years. In total, 62.3% were taking a biologic or JAK inhibitor, most commonly a tumor necrosis factor inhibitor (36.2%), and approximately a third (31.3%) of patients were taking concurrent prednisone.
In total, 23 (1.1%) patients had a positive COVID-19 diagnosis confirmed with a nasopharyngeal test and an additional 29 (1.4%) had a highly suspected COVID-19 infection in line with accounts of acute respiratory illness within 14 days of close contact with a confirmed case. A further 12.7% of patients described having respiratory symptoms but were deemed unlikely to have COVID-19 infection due to not being in contact with a confirmed case of COVID-19 within 14 days of symptom onset.
Among the treatments, prednisone was the only one independently associated with the risk for confirmed COVID-19, significantly increasing the risk 2.7-fold, after taking into account comorbidities, precautions taken to reduce the risk for infection, and contact with COVID-19 cases.
The researchers report that the increased risk for confirmed COVID-19 among patients taking prednisone was primarily associated with doses of 2.5 mg/day or above.
When a combination of confirmed or highly suspicious COVID-19 infections were included in the analysis, prednisone use remained a significant, independent risk factor, increasing the odds for infection by 23%, while taking biologics or JAK inhibitors significantly and independently lowered the risk by 53%.
The researchers note that there were no independent effects of conventional DMARDs, age, sex, or comorbidities.
Ennio Giulio Favalli (ASST Gaetano Pini-CTO Institute, Milan, Italy) and team say that “[g]iven the high proportion of subjects chronically taking [glucocorticoids] for [immune-mediated inflammatory diseases], the relevance of this information can certainly be crucial for the management of these fragile patients during the outbreak.”
But they highlight that the “results should not encourage indiscriminate suspension of [glucocorticoids].” Instead, they advise that “the use of [glucocorticoids] especially a dose >2.5 mg per day should be cautiously evaluated during the pandemic.”
Favalli et al conclude in Arthritis Research & Therapy that “this study provides all specialists facing the COVID-19 emergency with a very reassuring message about the possibility of suggesting [rheumatic and musculoskeletal disease] patients to continue their current therapy with [JAK inhibitors or biologics] without an increased risk and probably with a milder infection course.”
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Arthritis Res Ther 2020; 22: 290