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A systematic review suggests patients taking immunosuppressive therapy may not be at as heightened risk of infection as previously thought.
Coronavirus 2019 (COVID-19) infection among patients with rheumatic disease was surprisingly low in the findings from a new systematic review which sought to observe the burden of the pandemic on the potentially at-risk population.
A team of investigators from Texas reported findings at the American College of Rheumatology (ACR) Convergence 2020 this week showing that COVID-19 infection, disease severity, and associated mortality were low among patients with rheumatic disease through May of this year.
The findings complement other published data at ACR 2020 showing that initial fears for immunosuppressed patients in the field at the beginning of the pandemic may be assuaged by minimally observed effect from COVID-19.
Investigators, led by Akhil Sood, MD, an internal medicine resident at the University of Texas Medical Branch in Galveston, were following on exactly that early concern when they initiated their trial.
“When the pandemic started, there was concern on whether to continue or hold immune therapies among patients with rheumatic diseases because they are at increased risk for infection,” Sood said in a statement. “We were interested to see if these patients are at an increased risk for COVID-19 infection.”
And if such patients were to be infected, Sood said, clinicians would want to know the risk of disease course severity—so as to assure biologic therapy prescribing is managed responsibly during the pandemic.
Sood and colleagues conducted their systematic review of published articles between January – May of this year, seeking COVID-19 outcomes of patients with rheumatic disease. They extracted patient demographic information and use of biologic or targeted therapy from observed data.
Measured outcomes for their assessment included hospitalization, intensive care unit (ICU) admission, and death. Patients were stratified by “severe” or “non-severe” outcomes, based on clinical symptoms for COVID-19 and their need for hospitalization or ICU admission.
From their assessment, investigators found 8 observational cohort trials which included 6095 patients with rheumatic disease. Among them, just 123 patients (2%) were confirmed COVID-19 positive or highly suspicious for COVID-19 infection based on clinical indications. Among this subpopulation, the most commonly reported rheumatic diseases included rheumatoid arthritis (28%) and psoriatic arthritis (7%).
Approximately two-thirds (68%) of COVID-19 patients with rheumatic disease were on biologics at the time—most commonly, an anti-TNF agent (31%). Nearly three-fourths (73%) of patients with COVID-19 were not hospitalized. Of the 27% that were, 13 required ICU admission, and 4 died.
Investigators emphasized the need for larger cohort analyses to better examine COVID-19 outcomes among biologic versus non-biologic users, and factors including disease severity indexes and duration of therapy use were not considered in this assessment. However, the current findings indicate a low incidence of COVID-19 among rheumatic patients, and low risks for hospitalization or death in infected patients.
“We are waiting for additional extensive studies that include more patients with rheumatic disease on biologic and targeted therapies,” Sood said. “Another area of interest for us is examining risk factors for severe COVID-19 infection in patients with rheumatic disease. We hope this can help us identify which patients to closely monitor and possibly develop precautions to mitigate their risk.”
The study, “COVID-19 Infection Among Patients with Rheumatic Disease on Biologic & Targeted Therapies: A Systematic Review,” was presented at ACR 2020.