Data favor TNF inhibitor monotherapy for IMIDs during COVID-19 pandemic
medwireNews: Tumor necrosis factor (TNF) inhibitor monotherapy is associated with a lower risk for COVID-19-related hospitalization or death than other common immunomodulatory treatments given to people with immune-mediated inflammatory diseases (IMIDs), research suggests.
The pooled analysis of data from three international COVID-19 registries (GRA, SECURE-IBD, and PsoProtect) included 6077 individuals (mean age 48.8 years, 58.6% women) with inflammatory arthritis, inflammatory bowel disease, or psoriasis from 74 countries.
The most common IMID diagnoses were rheumatoid arthritis (35.3%), Crohn’s disease (25.3%), ulcerative colitis (12.5%), spondyloarthritis (10.3%), psoriatic arthritis (9.3%), and psoriasis (4.9%).
Just under half (46.8%) of participants were receiving TNF inhibitor monotherapy, 25.4% were receiving methotrexate monotherapy, and 11.0% were receiving both. Smaller proportions were undergoing treatment with azathioprine/6-mercaptopurine alone (6.5%) or in combination with a TNF inhibitor (5.5%), or with Janus kinase (JAK) inhibitor monotherapy (4.7%).
Zara Izadi (University of California, San Francisco, USA) and co-investigators report that, between March 12, 2020 and February 1, 2021, 21.3% of participants were hospitalized with COVID-19 and 3.1% died with the infection.
After controlling for age, sex, smoking status, disease activity, comorbidity, and glucocorticoid dose, the researchers found that individuals receiving methotrexate monotherapy were a significant two times more likely to be hospitalized or die with COVID-19 than those receiving TNF inhibitor monotherapy.
The likelihood of hospitalization or death was also significantly higher among the patients receiving azathioprine/6-mercaptopurine monotherapy (odds ratio [OR]=1.84), azathioprine/6-mercaptopurine plus a TNF inhibitor (OR=1.74), or JAK inhibitor monotherapy (OR=1.82), relative to those on TNF inhibitor monotherapy.
There was no significantly increased risk, however, among people receiving a TNF inhibitor plus methotrexate, which Izadi and team say “is possibly associated with the use of lower methotrexate doses in combination therapy compared with monotherapy.”
Writing in JAMA Network Open, the authors conclude that their “findings support the continued use of TNF inhibitor monotherapy among individuals with IMIDs during the pandemic.”
They add that the results suggest “that clinicians would benefit from weighing the risks vs benefits of deescalating treatment or changing medications when a patient is receiving concomitant TNF inhibitors and azathioprine/6-mercaptopurine.”
In an accompanying comment, Licio Velloso, from the University of Campinas in São Paolo, Brazil, says: “The finding that maintenance of TNF inhibitor monotherapy is associated with reductions in the risk of severe COVID-19 among patients with IMIDs offers new perspective that may guide health care professionals in the difficult decisions regarding therapeutic approaches among this specific group of patients.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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