The results of the combined effectiveness analysis in the meta-analysis found no significant differences between the conventional strategy and monotherapy. This strategy is considered recommended (level A evidence) in patients with no history of previous failure of protease inhibitor, with undetectable plasma viral load and signs or symptoms of nucleoside/nucleotide toxicity.

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BackgroundThe disease modifying antirheumatic drugs (DMARD) impair the immune response of patients with immune-mediated inflammatory diseases (IMID).ObjectivesTo analyze the seroprevalence of SARS-CoV-2 in patients with IMID treated with biological disease modifying antirheumatic drugs (bDMARD) or targeted synthetic (tsDMARD).MethodsAn ambispective cross-sectional study was performed in patients with IMID treated with bDMARD or tsDMARD. Seroprevalence was compared by measuring IgG against SARS-CoV-2 between October 2020 and May 2021.ResultsA total of 550 patients with IMID were studied, all of them on bDMARD or tsDMARD therapy, none of them vaccinated at that time against SARS-CoV-2. Patients receiving anti-TNFα therapy had a higher seroprevalence than other biologic and synthetic targeted therapies (OR= 1.792; 95% CI 1.088-2.951; p= 0.021).Patients with bDMARD or tsDMARD treated concomitantly with some type of conventional synthetic DMARD (csDMARD) presented a lower seroprevalence compared to patients treated in monotherapy, 10.7 vs. 19.9% (p= 0.003). When analyzing the treatments with the different csDMARD separately (methotrexate, leflunomide, sulfasalazine, azathioprine, hydroxychloroquine and the others), methotrexate was determined to influence in a lower seroprevalence, compared to those who did not receive any csDMARD, 9.8 vs 19.9% (OR= 0.439, 95% CI 0.232-0.828; p= 0.011). When evaluating the influence of methotrexate on seroprevalence among the different groups of bDMARD or tsDMARD, a lower seroprevalence was demonstrated in the group of patients receiving anti-TNFα and methotrexate in combination, versus patients on this bDMARD in monotherapy, 10.1 vs 24.1% (OR= 0.355, 95% CI 0.165 - 0.764; p=0.006). No significant differences were identified with the other bDMARD.Regarding the patients’ IMIDs, no differences in seroprevalence were observed when compared by disease groups with each other.ConclusionSeroprevalence in the group of patients with IMID is influenced according to the therapy received, being higher in patients receiving anti-TNFα monotherapy, but significantly lower if concomitant to this drug they receive methotrexate. These differences are not seen with the other b/tsDMARD and csDMARD.References[1]Muñoz-Fernández S, Cebrian L, Thuissard IJ, Martina Steiner M, García-Yubero C, Esteban AV et al. Incidence of COVID-19 in 902 Patients With Immunomediated Inflammatory Diseases Treated With Biologics and Targeted Synthetic Disease-Modifying Antirheumatic Drugs-Findings From the BIOCOVID Study. J Clin Reumatol. 2022 Mar 1; 28(2): e348-e352.[2]Favalli EG, Gobbini A, Bombaci M, Maioli G, et al. The Impact of Anti-rheumatic Drugs on the Seroprevalence of Anti-SARS-CoV-2 Antibodies in a Cohort of Patients With Inflammatory Arthritis: The MAINSTREAM Study. Front Med (Lausana), March 2022.[3]Simon D, Tascilar K, Kleyer A, Fagni F, Krönke G, Médeet C et al. Impact of cytokine inhibitor therapy on the prevalence, seroconversion rate and longevity of the humoral immune response against SARSCoV- 2 in an unvaccinated cohort. Arthritis & Rheumatology Vol. 74, No. 5, May 2022, pp 783–790AcknowledgementsOlga Reillo from Hospital Universitario Infanta Sofía (Librarian - Documentalist)Disclosure of InterestsNone Declared.

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