Highlights from

EULAR 2021

European Congress of Rheumatology

Virtual 2-5 June 2021

Rituximab or JAKi therapies in rheumatoid arthritis increase the risk of severe COVID-19

Summary: The risk of severe COVID-19 outcomes in patients with rheumatoid arthritis (RA) is four times higher for rituximab users and two times higher for JAK inhibitor users compared with TNF inhibitor users. This association was not found for abatacept and IL-6-inhibiting DMARDs. This was concluded from a large study comparing COVID-19 severity in RA patients on different classes of DMARDs. These results demonstrated the importance of risk-mitigation strategies in RA patients on rituximab or JAK inhibitors.

To examine the effect of baseline use of different DMARD classes on COVID-19 severity in RA, 2,869 patients with resolved COVID-19 were selected from the global rheumatology alliance physician registry. Treatment with rituximab, JAK inhibitors, abatacept, or IL-6 inhibitors was compared with TNF inhibitors (reference group) on an ordinal COVID-19 severity scale (1: not hospitalised; 2: hospitalised without oxygen; 3: hospitalised with oxygen or ventilation; 4: death). Data was analysed via ordinal logistic regression analysis. The results demonstrated that patients treated with rituximab or JAK inhibitors had a four-fold or two-fold increased risk of severe COVID-19 outcomes, respectively, compared with the reference group. In 85.4% of the cases, TNF inhibitor users were not hospitalised as a consequence of COVID-19. These percentages were significantly smaller in patients on rituximab (57.7%) or JAK inhibitors (72.6%). Baseline users of abatacept or IL-6 inhibitors were not hospitalised in 76.4% and 85.5% of the cases. In addition, rituximab or JAK inhibitor use at COVID-19 onset resulted more often in hospitalisation with oxygen or ventilation (rituximab 22.0%; JAK inhibitors 15.3%; TNF inhibitors 7.4%) or death (rituximab 14.8%; JAK inhibitors 7.1%; TNF inhibitors 2.6%) than TNF inhibitor use. Dr Jeffrey Sparks (Brigham and Women’s Hospital, US), who presented the results of this study, stressed the importance of COVID-19 risk management in RA patients on rituximab or JAK inhibitors, such as prioritising them for vaccination.

  1. Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: results from the COVID-19 Global Rheumatology Alliance Physician Registry. OP0006, EULAR 2021 Virtual Congress, 2-5 June 2021

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Article image: SoumenNath

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