Incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases treated with targeted biologic and synthetic disease-modifying anti-rheumatic drugs

Abstract

To investigate the incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases receiving targeted biologic and synthetic disease modifying anti-rheumatic drugs (tDMARDs) and to explore the possible effect of these treatments in the clinical expression of COVID-19. Methods: A cross-sectional study comprising of a telephone survey and electronic health records review was performed including all adult and paediatric patients with rheumatic diseases treated with tDMARDs in a large rheumatology tertiary centre in Barcelona, Spain. Demographics, disease activity, COVID-19 related symptoms and contact history data were obtained from the start of the 2020 pandemic. Cumulative incidence of confirmed cases (SARS-CoV-2 positive PCR test) was compared to the population estimates for the same city districts from a governmental COVID-19 health database. Suspected cases were defined following WHO criteria and compared to those without compatible symptoms. Results: 959 patients with rheumatic diseases treated with tDMARDs were included. We identified 11 confirmed SARS-CoV-2 positive cases in the adult cohort and no confirmed positive cases in the paediatric cohort. COVID-19 incidence rates of the rheumatic patient cohort were very similar to that of the general population [(0.48% (95% CI 0.09 to 0.87%)] and [0.58% (95% CI 0.56 to 0.60%)], respectively. We found significant differences in tDMARDs proportions between the suspected and non-suspected cases (p=0.002). Conclusion: Adult and paediatric patients with rheumatic diseases on tDMARDs do not seem to present a higher risk of COVID-19 or a more severe disease outcome when compared to general population.

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

“…Additionally, a large portion of our cohort of infected patients (n = 13) was frequently hospitalized (61.5%) and had a high mortality rate (23.1%). Few studies have described SARS-CoV-2 infection among RMD patients and those that undergo immunosuppressive treatments, but all of them have reported lower hospitalization and death rates compared to our patients, with mortality ranging between 0 and 10% [4][5][6][11][12][13]. However, given the small number of patients in these studies, very few have analyzed specific risk factors related to immunosuppressive therapies, and most of them have reported higher hospitalization rates for patients receiving chronic glucocorticoids compared to those not receiving them [4,6,8].…”

“…COVID-19 severity ranges from asymptomatic to severe, and the disease can result in acute respiratory distress syndrome (ARDS) and cytokine storm, which have led to death in 3-10% of the infected population. Patients with rheumatic and musculoskeletal diseases (RMDs) are at high risk for infections related to their disease, comorbidities, or immunosuppressive treatments [3], but recent studies regarding COVID-19 did not support higher mortality in these patients [4][5][6][7]. However, there are few data regarding specific risk factors for unfavorable outcomes, such as specific diseases or immunosuppressive drugs [5].…”

“…Patients with rheumatic and musculoskeletal diseases (RMDs) are at high risk for infections related to their disease, comorbidities, or immunosuppressive treatments [3], but recent studies regarding COVID-19 did not support higher mortality in these patients [4][5][6][7]. However, there are few data regarding specific risk factors for unfavorable outcomes, such as specific diseases or immunosuppressive drugs [5]. Further, some reports have suggested the worst prognosis for RMD patients who were treated with rituximab and developed SARS-CoV-2 infection [8,9].…”

Patients with juvenile idiopathic arthritis on TNF inhibitors exposed to COVID-19 family members

“…We read with great interest the study by Michelena et al [1] investigating the incidence of the Coronavirus 19 disease (COVID-19) among adult and pediatric patients with rheumatic disease receiving anti-rheumatic drugs. They found an incidence rate comparable with general populations and they did not observe an increased risk of severe COVID-19.…”

Response to: ‘Hydroxychloroquine ineffective for COVID-19 prophylaxis in lupus and rheumatoid arthritis’ by Singeret al

“…3 Patients with systemic RMD had similar rates of COVID-19 compared with the general population according to several reports. [7][8][9] In contrast, patients with RMD had a higher prevalence of PCR-confirmed COVID-19 compared with the reference population (0.76% vs 0.58%, OR=1.32, 95% CI 1.15 to 1.52) in a Spanish study. 10 However, that study only identified patients presenting to emergency departments, and patients with a milder disease were not included.…”