medwireNews: Findings from a systematic review and meta-analysis suggest that hydroxychloroquine is not associated with benefits or harms in terms of COVID-19 mortality, and more studies are needed to establish whether other rheumatology drugs could be used to treat the disease.
Michael Putman (Northwestern University, Chicago, Illinois, USA) and colleagues from the COVID-19 Global Rheumatology Alliance analyzed data from four randomized controlled trials, 29 cohort studies, and 12 case series assessing clinical outcomes in hospitalized patients with SARS-CoV-2 infection who were treated with antirheumatic disease therapy.
They report in Arthritis & Rheumatology that hydroxychloroquine use was not significantly associated with death risk in a pooled analysis of three cohort studies with low bias, nor with the composite outcome of invasive mechanical ventilation and mortality in two cohort studies with low bias, providing support for “a growing consensus that antimalarial therapies for COVID-19 should be limited to use in ongoing clinical trials.”
For other rheumatology drugs, however, Putman and team found that the evidence supporting their use for COVID-19 “is currently inconclusive.”
For instance, meta-analysis of two cohort studies showed that the interleukin (IL)-1 receptor inhibitor anakinra was associated with a significant reduction in COVID-19 mortality risk (hazard ratio =0.2), but the team says that this result “should be interpreted with caution” because “[o]ne study did not adequately control for confounders, and the other study used a historical cohort as a comparator group.”
They add that “available data for IL-6 inhibition were similarly limited,” with seven studies of tocilizumab finding “frequently conflicting” results.
“It should be noted that both IL-1 and IL-6 inhibitors were typically used for patients with moderate to severe acute respiratory distress syndrome,” and while press releases from ongoing trials of these therapies have been “encouraging,” further peer-reviewed studies “will be essential in determining the role of these therapies,” they add.
Similarly, Putman and team note that “no definitive conclusions could be drawn” from their data synthesis of 14 studies investigating glucocorticoid use for COVID-19.
Together, these findings indicate that “[a]ntirheumatic disease therapies should be investigated further in randomized controlled trials,” they write.
And the investigators conclude: “In the interim, physicians should be cautious in offering off label antirheumatic disease therapies to patients with COVID-19 based on the currently available literature.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
10 August 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.