What Does COVID-19 Look Like in Patients Taking Immunosuppressive Agents?

Many unknowns remain about COVID-19, with researchers working to discover good information. One area of exploration is how different medications may affect patients who contract COVID-19, particularly immunosuppressed patients. Recently, researchers examined outcomes associated with COVID-19 among patients with underlying rheumatic diseases taking immunosuppressive agents.

“In the medical community, Rheumatologists are particularly concerned because their patients represent a population of autoimmune rheumatic disorders who are mostly on immunosuppressive agents and are susceptible to infection. While much has been learnt on COVID-19 in general, little is known of COVID-19 severity and outcomes in patients with rheumatic diseases (RD),” explained the study authors.

The present study was a retrospective chart review of COVID-19 patients with rheumatic diseases who were taking disease-modifying antirheumatic drugs (DMARDs). The researchers also performed a literature search and assessed similar studies of single cases and case series.

The retrospective chart review included four COVID-19 inpatients with rheumatic diseases (mean age, 57 years). Half of the patients had a mild infection, and the other half progressed to severe disease and presented respiratory complications; one severe case on secukinumab required mechanical ventilation, and the other on rituximab developed viral pneumonia and needed supplemental oxygenation. Elevated acute phase reactants wee observed in all four patients; two patients with mild COVID-19 presented lymphopenia, and two patients with severe COVID-19 had normal lymphocyte counts and elevated IL-6 levels. No patients experienced exacerbations of their underlying rheumatic diseases.

The literature review yielded nine relevant COVID-19 studies encompassing 197 cases of patients with inflammatory rheumatic diseases. The majority of patients were taking DMARDs or biologics, the most commonly used being anti-tumor necrosis factor (TNF) inhibitors. Two patients taking tocilizumab had a mild infection. Two patients were taking rituximab, one of whom had severe infection and required mechanical ventilation. Six patients were taking secukinumab, one of whom was hospitalized.

Twelve patients died, for an estimated overall mortality rate for the 201 cases—the four from the researchers’ hospital and the 197 identified in the literature review—of 5.9%.

The study will appear in the August issue of Seminars in Arthritis and Rheumatism.

The study authors concluded that, “RD patients are susceptible to COVID-19. Various DMARDs may affect the viral process differently. Patients on etanercept, [hydroxychloroquine], or tocilizumab may run a mild course of the viral illness. Rituximab or secukinumab could worsen the viral disease and its related complications.” They called for larger studies in the future.