COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs

Jih-Jin Tsai; Li-Teh Liu; Chun-Hong Chen; Liang-Jen Chen; Shiow-Ing Wang; James Cheng-Chung Wei

doi:10.1136/rmdopen-2023-003038

COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs

RMD Open. 2023 Jul;9(3):e003038. doi: 10.1136/rmdopen-2023-003038.

Authors

Jih-Jin Tsai^{1

2

3}, Li-Teh Liu⁴, Chun-Hong Chen^{5

6}, Liang-Jen Chen⁷, Shiow-Ing Wang^#^{8

9}, James Cheng-Chung Wei^#^{10

11

12

13}

Affiliations

¹ Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
² Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
³ School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Medical Laboratory Science and Biotechnology, College of Medical Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan.
⁵ National Mosquito-Borne Diseases Control Research Center, National Health Research Institutes, Zhunan, Taiwan.
⁶ National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
⁷ Department of Family Medicine, Pingtung Christian Hospital, Pingtung, Taiwan.
⁸ Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan jccwei@gmail.com shiowing0107@gmail.com.
⁹ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁰ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan jccwei@gmail.com shiowing0107@gmail.com.
¹¹ Department of Allergy Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.
¹² Department of Nursing, Chung Shan Medical University, Taichung, Taiwan.
¹³ Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.

^# Contributed equally.

Abstract

Objectives: We aimed to investigate the role of rheumatoid arthritis (RA) with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) exposure in COVID-19 outcomes.

Methods: Our study retrieved data from the US Collaborative Network in TriNetX between 1 January 2018 and 31 December 2022. We investigated b/tsDMARD use for RA: interleukin 6 inhibitor (IL-6i), Janus-associated kinase inhibitors (JAKi) or tumour necrosis factor-alpha inhibitors (TNFi, reference group). The outcomes of COVID-19 were the incidence of infection and adverse outcomes (hospitalisation, critical care services, mechanical ventilation and mortality). The HR and 95% CI of the outcomes were calculated between propensity score-matched (PSM) patients with different b/tsDMARDs.

Results: After PSM, 2676 JAKi vs 2676 TNFi users and 967 IL-6i vs 967 TNFi users were identified. As for COVID-19 incidence, JAKi users did not reach statistical significance (HR: 1.058, 95% CI: 0.895 to 1.250) than TNFi users. RA with JAKi users had a significant risk for hospitalisation (HR: 1.194, 95% CI: 1.003 to 1.423), mortality (HR: 1.440, 95% CI: 1.049 to 1.976) and composite adverse outcomes (HR: 1.242, 95% CI: 1.051 to 1.468) compared with TNFi users. Mortality risk tended to be significantly higher in the JAKi group without COVID-19 vaccination (HR: 1.511, 95% CI: 1.077 to 2.121). IL-6i users compared with TNFi users did not have the above findings.

Conclusions: RA with JAKi users had a significant risk for hospitalisation, mortality or composite adverse outcomes, especially higher mortality among those without COVID-19 vaccination. COVID-19 vaccination should be encouraged in these target cohorts. When using JAKi for patients with RA, clinicians should be vigilant about these adverse outcomes to prevent their occurrence or detect them early for early intervention.

Keywords: Autoimmune Diseases; Biological Therapy; COVID-19; Outcome Assessment, Health Care; Rheumatoid Arthritis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antirheumatic Agents* / adverse effects
Arthritis, Rheumatoid* / complications
Arthritis, Rheumatoid* / drug therapy
COVID-19 Vaccines
COVID-19* / epidemiology
Critical Care
Humans
Janus Kinase Inhibitors* / adverse effects

Substances

COVID-19 Vaccines
Antirheumatic Agents
Janus Kinase Inhibitors