COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs
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 Dec...
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BMJ Publishing Group
2023-07-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/9/3/e003038.full |
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| author | James Cheng-Chung Wei Jih-Jin Tsai Li-Teh Liu Chun-Hong Chen Liang-Jen Chen Shiow-Ing Wang |
| author_facet | James Cheng-Chung Wei Jih-Jin Tsai Li-Teh Liu Chun-Hong Chen Liang-Jen Chen Shiow-Ing Wang |
| author_sort | James Cheng-Chung Wei |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0a7be681fae345f4b89bd25bb3f23699 |
| institution | DOAJ |
| issn | 2056-5933 |
| language | English |
| publishDate | 2023-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-0a7be681fae345f4b89bd25bb3f236992025-08-20T03:23:37ZengBMJ Publishing GroupRMD Open2056-59332023-07-019310.1136/rmdopen-2023-003038COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDsJames Cheng-Chung Wei0Jih-Jin Tsai1Li-Teh Liu2Chun-Hong Chen3Liang-Jen Chen4Shiow-Ing Wang54 Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan2 Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan4 Department of Medical Laboratory Science and Biotechnology, College of Medical Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan5 National Mosquito-Borne Diseases Control Research Center, National Health Research Institutes, Zhunan, Taiwan7 Department of Family Medicine, Pingtung Christian Hospital, Pingtung, Taiwan8 Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, TaiwanObjectives 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.https://rmdopen.bmj.com/content/9/3/e003038.full |
| spellingShingle | James Cheng-Chung Wei Jih-Jin Tsai Li-Teh Liu Chun-Hong Chen Liang-Jen Chen Shiow-Ing Wang COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs RMD Open |
| title | COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs |
| title_full | COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs |
| title_fullStr | COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs |
| title_full_unstemmed | COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs |
| title_short | COVID-19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic DMARDs |
| title_sort | covid 19 outcomes in patients with rheumatoid arthritis with biologic or targeted synthetic dmards |
| url | https://rmdopen.bmj.com/content/9/3/e003038.full |
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