Low Risk of COVID in Biologic Treated Rheum Patients Save

In an Annals of Rheumatic Disease report, Italian investigators performed consecutive testing for SARS-CoV-2 (IgM and IgG) between 25 March to 25 May 2020 and compared test results between rheumatic disease (RMD) patients and the general population. 

Their study included 295 RMD patients with rheumatoid arthritis (46.8%), psoriatic arthritis (25.8%), ankylosing spondylitis other rheumatic diseases (8.8%) - 8 with systemic lupus erythematosus, 12 with giant cell arthritis and 6 with polymyositis. 

Testing showed only six out of 295 patients (2.03%) were positive for IgM or IgG anti SARS-CoV-2; and 4 patients of these (66.7%) had SARS-CoV-2 confirmed by nasal pharyngeal swab. All 4 women w/ COVID were hospitalised for SARS-CoV-2 pneumonia. 

The incidence of COVID-19 in RMD patients taking a biologic (b-DMARDs) was 4/295 (1.4%), while the population was 0.5% (OR 3.01;95% CI 1.13 to 8.09; p value 0.047). Their data suggests a tendency for an increase risk of COVID-19 infection in patients receiving b-DMARD.

The two patients with positive serological tests but negative nasopharyngeal swab tests were asymptomatic; one RA patient receiving baricitinib and another ankylosing spondylitis receiving secukinumab.

Their results are different than the COVID-19 Global Rheumatology Alliance Registry who reported a greater risk of COVID hospitalisation for prednisone doses of ≥10 mg but a protective efffect when biologic or targeted synthetic DMARDS were used.