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03-04-2020 | Rheumatology | News | Article

Preliminary findings suggest no need for preventive DMARD withdrawal during COVID-19 pandemic

Author: Claire Barnard

medwireNews: The first report of patients with rheumatic diseases and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection in Italy suggests that people treated with biologic (b) or targeted synthetic (ts) DMARDs may not be at increased risk for severe complications from COVID-19.

Sara Monti (IRCCS Fondazione Policlinico San Matteo, Pavia) and colleagues report their experience of 320 patients with chronic arthritis aged an average of 55 years, of whom 57% had rheumatoid arthritis and 43% had spondyloarthritis. Over half (52%) of the patients were treated with tumor necrosis factor (TNF) inhibitors, while 40% were given non-TNF biologics and 8% tsDMARDs.

In all, four patients developed confirmed COVID-19 as identified through rhinopharyngeal swabs, and a further four patients experienced symptoms that were “highly suggestive” of the disease, say Monti et al.

Among these eight patients, four were undergoing etanercept treatment, two received abatacept, while one each received the Janus kinase (JAK) inhibitors tofacitinib and baricitinib. Three patients were also receiving concomitant methotrexate, three were taking hydroxychloroquine, and four glucocorticoids.

Monti and team say that all patients temporarily withdrew biologic or JAK inhibitor treatment at the time of COVID-19 symptom onset, and “there have been no significant relapses of the rheumatic disease” at the time of reporting.

They add that none of the patients with confirmed or suggestive COVID-19 developed severe respiratory complications or died; one 65-year-old individual required hospital admission and low-flow oxygen supplementation.

The team also notes that among 700 people with severe COVID-19 who were admitted to their hospital, none were receiving biologic or tsDMARD treatment.

“[O]ur preliminary experience shows that patients with chronic arthritis treated with bDMARDs or tsDMARDs do not seem to be at increased risk of respiratory or life-threatening complications from SARS-CoV-2 compared with the general population,” Monti and colleagues write in a letter published in the Annals of the Rheumatic Diseases.

“Although continuous surveillance of patients with rheumatic diseases receiving immunosuppressive drugs is warranted, these data can support rheumatologists for the management and counselling of their patients, avoiding the unjustifiable preventive withdrawal of DMARDs, which could lead to an increased risk of relapses and morbidity from the chronic rheumatological condition,” they continue.

They caution, however, that “[o]ur findings do not allow any conclusions on the incidence rate of SARS-CoV-2 infection in patients with rheumatic diseases, nor on the overall outcome of immunocompromised patients affected by COVID-19.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

3 April 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.

Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-217424