NSAIDs, DMARDs May Not Increase Hospitalization Risk in COVID-19 Patients

The use of non-steroidal anti-inflammatory drugs (NSAIDs) and conventional disease-modifying antirheumatic drugs (DMARDs) did not increase hospitalization risk among rheumatic patients with COVID-19, according to new findings.

“In general, immunosuppression and the presence of comorbidities are associated with an increased risk of serious infection in people with rheumatic diseases therefore, people with rheumatic disease may be at higher risk for a more severe course with COVID-19, including hospitalisation, complications and death,” the study authors explained. “Importantly, some medications used to treat rheumatic diseases, such as hydroxychloroquine and interleukin-6 (IL-6) inhibitors, are being studied for the prevention and/or treatment of COVID-19 and its complications including cytokine-storm. At present, the implications of COVID-19 for people living with rheumatic diseases remain poorly understood.”

To better understand the impact of COVID-19 on rheumatic patients, researchers created the COVID-19 Global Rheumatology Alliance (C19-GRA). The C19-GRA collects data to share with patients, providers, and organizations. It houses patient and provider registries. In the latter, providers input data on their patients who have been diagnosed with COVID-19.

The present study was a case series of the first 600 patients entered into the C19-GRA provider registry (median age, 56 years; 71% were female). Patients were from 40 different countries. The most common diagnosis was rheumatoid arthritis (38%), followed by systemic lupus erythematosus (14%) and psoriatic arthritis (12%). Just under half of patients (46%) were hospitalized; 55 patients (9%) died. Multivariable-adjusted models found a correlation between prednisone dose ≥10 mg/day and increased hospitalization risk (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.06 to 3.96). Hospitalization risk did not increase with conventional DMARD use, either alone (OR, 1.23; 95% CI, 0.70 to 2.17) or in combination with biologics/Janus Kinase inhibitors (OR, 0.74; 95% CI, 0.37 to 1.46). NSAID use did not increase hospitalization risk, either (OR, 0.64; 95% CI, 0.39 to 1.06). Patients using tumor necrosis factor inhibitors (anti-TNFs) had a lower hospitalization risk (OR, 0.40; 95% CI, 0.19 to 0.81). Antimalarials were not associated with hospitalization (OR, 0.94; 95% CI, 0.57 to 1.57).

The study was published in Annals of the Rheumatic Diseases.

“This series of cases demonstrates that the majority of patients with rheumatic diseases captured in our registry recover from COVID-19. In some cases, exposure to specific medication classes is associated with lower odds of hospitalisation; however, these findings should be interpreted with caution because of a high risk of bias. Results support the guidance issued by the American College of Rheumatology and the European League Against Rheumatism, which suggest continuing rheumatic medications in the absence of COVID-19 infection or SARS-CoV-2 exposure,” the authors summarized. They added that the C19-GRA databases are still collecting information; new data will allow for more detailed future analyses.