Methotrexate as a safe immunosuppressive agent during the COVID-19 pandemic

Ganjei, Zakiye; Dana, Hoorvash Faraji; Ebrahimi‐Dehkordi, Sepehr; Alidoust, Fereshte; Bahmani, Kiumars

doi:10.1016/j.intimp.2021.108324

Cited by 17 publications

(16 citation statements)

References 37 publications

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“…25 Future analyses will determine how quickly prescribing behaviour reverts to pre-pandemic practice, particularly in light of evidence supporting the use of medications such as methotrexate and anti-TNF inhibitors without an adverse impact on COVID-19 outcomes. 26 27…”

Section: Discussionmentioning

confidence: 99%

Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic: a population-level cohort study using OpenSAFELY

Russell

Galloway

Andrews

et al. 2022

Preprint

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Objective: To use the OpenSAFELY platform to replicate key metrics from a national clinical audit, and assess the impact of COVID-19 on disease incidence and care delivery for inflammatory arthritis (IA) in England. Design: Population-based cohort study, with the approval of NHS England. Setting: Primary care and linked hospital outpatient data for more than 17 million people registered with general practices in England that use TPP electronic health record software. Participants: Adults (18-110 years) with new diagnoses of IA (rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, undifferentiated IA) between 1 April 2019 and 31 March 2022. Main outcome measures: The following outcomes were explored before and after April 2020: 1) incidence of IA diagnoses; 2) time from primary care referral to first rheumatology assessment; 3) time to first prescription of a disease-modifying anti-rheumatic drug (DMARD) in primary care. Results: From a reference population of 17,683,500 adults, there were 31,280 incident IA diagnoses between April 2019 and March 2022. The incidence of IA decreased by 20.3% in the year commencing April 2020, relative to the preceding year (5.1 vs. 6.4 diagnoses per 10,000 adults, respectively). For those who presented with IA, the time to first rheumatology assessment was shorter during the pandemic (median 18 days; interquartile range 8 to 35 days) than before (21 days; 9 to 41 days). Overall, the proportion of patients prescribed DMARDs in primary care was comparable during the pandemic to before; however, the choice of medication changed, with fewer people prescribed methotrexate or leflunomide during the pandemic, and more people prescribed sulfasalazine or hydroxychloroquine. Conclusions: The incidence of IA diagnoses in England decreased markedly during the early COVID-19 pandemic. However, for people who sought medical attention, the impact of the pandemic on service delivery was less marked than might have been anticipated. This study demonstrates that it is feasible to use routinely captured, near real-time data in the secure OpenSAFELY platform to benchmark care quality for long-term conditions on a national scale, without the need for manual data collection.

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Section: Discussionmentioning

confidence: 99%

Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic: a population-level cohort study using OpenSAFELY

Russell

Galloway

Andrews

et al. 2022

Preprint

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“…More importantly, data from a global electronic database (42) showed no statistically significant difference in hospitalization rates in COVID-19 patients exposed to methotrexate compared to those not exposed to methotrexate. Additionally, Ganjei et al (43) found that patients with aplastic anemia taking low dose methotrexate had significantly less severe symptoms of COVID-19 than their families with normal immune systems. This demonstrates a potential protective effect of methotrexate on the progression of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Risk of COVID-19 infection, hospitalization and mortality in psoriasis patients treated with interleukin-17 inhibitors: A systematic review and meta-analysis

Liu

Wang²,

Liu³

et al. 2022

Front. Immunol.

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BackgroundCoronavirus disease 2019 (COVID-19) have brought great disaster to mankind, and there is currently no globally recognized specific drug or treatment. Severe COVID-19 may trigger a cytokine storm, manifested by increased levels of cytokines including interleukin-17 (IL-17), so a new strategy to treat COVID-19 may be to use existing IL-17 inhibitors, which have demonstrated efficacy, safety and tolerability in the treatment of psoriasis. However, the use of IL-17 inhibitors in patients with psoriasis during the COVID-19 pandemic remains controversial due to reports that IL-17 inhibitors may increase the risk of respiratory tract infections.ObjectivesThe systematic review and meta-analysis aimed to evaluate the effect of IL-17 inhibitors on the risk of COVID-19 infection, hospitalization, and mortality in patients with psoriasis.MethodsDatabases (including Embase, PubMed, SCI-Web of Science, Scopus, CNKI, and the Cochrane Library) were searched up to August 23, 2022, for studies exploring differences in COVID-19 outcomes between psoriasis patients using IL-17 inhibitors and those using non-biologics. Two authors independently extracted data and assessed the risk of bias in a double-blind manner. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and heterogeneities were determined by the Q test and I2 statistic. And the numbers needed to treat (NNTs) were calculated to assess the clinical value of IL-17 inhibitors in preventing SARS-CoV-2 infection and treating COVID-19.ResultsNine observational studies involving 7,106 participants were included. The pooled effect showed no significant differences in the rates of SARS-CoV-2 infection (P = 0.94; I2 = 19.5%), COVID-19 hospitalization (P = 0.64; I2 = 0.0%), and COVID-19 mortality (P = 0.32; I2 = 0.0%) in psoriasis patients using IL-17 inhibitors compared with using non-biologics. Subgroup analyses grouped by age and COVID-19 cases, respectively, revealed consistent results as above. Meanwhile, the pooled NNTs showed no significant differences between the two groups in the clinical value of preventing SARS-CoV-2 infection and treating COVID-19.ConclusionThe use of IL-17 inhibitors in patients with psoriasis does not increase the risk of SARS-CoV-2 infection or worsen the course of COVID-19.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022335195.

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“…4 NF‐kB activation, which leads to the release of many cytokines, and elevated IFN and IL‐6, are linked to AA pathology and might cause hair loss. 5 AZD1222 expresses the S glycoprotein, which stimulates both antibody production and Th1 cell activation. 4 This type of hair loss has also been noticed among recipients of other types of COVID‐19 vaccines, such as BNT162b2 (Pfizer–BioNTech) and mRNA‐1273 (Moderna) 6 (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%