Abstract
The effect of immunosuppressant treatments on the incidence of coronavirus disease (COVID-19) remains largely unknown. We studied the association between the pre-exposure to disease-modifying antirheumatic drugs (DMARDs) that decrease immunological responses and the incidence of COVID-19 to explore the possible effects of these treatments in early manifestations of the disease. For this purpose, we performed a cross-sectional study including 2,494 patients with immunomediated inflammatory diseases (IMIDs) recruited at the outpatient Rheumatology, Dermatology and Gastroenterology services of Hospital del Mar. The primary outcome was the clinical diagnosis of COVID-19 performed by a physician at the hospital or at the primary care center, from the March 1–29, 2020. Multivariable Poisson regression models were fitted to estimate COVID-19 relative risk (RR) adjusted by comorbidities. We revealed that biological (RR = 0.46, CI 95% = 0.31–0.67) and synthetic (RR = 0.62, CI 95% = 0.43–0.91) DMARDs used in IMIDs diminished the incidence of COVID-19. Striking sex differences were revealed with anti-TNFα compounds (RR = 0.50, CI 95% = 0.33–0.75) with higher effects in women (RR = 0.33, CI 95% = 0.17–0.647). Treatment with low glucocorticoid doses also revealed sex differences decreasing the incidence of COVID-19 predominantly in women (RR = 0.72, CI 95% = 0.42–1.22). Our results report a decreased incidence of COVID-19 in patients receiving specific DMARDs with different immunodepressor mechanisms with striking sex differences. These results underline the interest of repurposing specific DMARDs for the possibility of minimizing the severity of disease progression in the early stages of COVID-19.
Highlights
Since December 2019, cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leading to a novel disease called COVID-19 were initially identified in China
The COVID-19 Global Rheumatology Alliance studied the demographic and clinical factors associated with COVID-19 hospitalization in rheumatic patients and found that a ≥10 mg/day glucocorticoid dose was associated with a higher odds of hospitalization, whereas anti-TNFα present a decreased incidence or hospitalizations
This is a cross-sectional study aimed to evaluate the effect of different disease-modifying antirheumatic drugs (DMARDs) on the accumulated incidence of COVID19 during March 2020 in patients with immunomediated inflammatory diseases (IMIDs) living in Barcelona (Spain)
Summary
Since December 2019, cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leading to a novel disease called COVID-19 were initially identified in China. SARS-CoV-2 infection causes respiratory symptoms that range from mild forms of presentation to more serious ones that can risk patients’ lives, causing pneumonia, and damage to other organs, the immune and blood system (Chen et al, 2020; Huang et al, 2020; Wang et al, 2020) This disease has rapidly expanded to multiple countries leading to a pandemic situation in March 2020 affecting 7.360.239 individuals worldwide, with a global mortality of 416.201 deaths on June 11th. A trend to a higher incidence of hospitalization was observed with chronic glucocorticoid treatment
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