Artikel
Does TNF-inhibition decrease the risk of severe COVID-19 in RMD-patients?
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Autoren
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Rebecca Hasseli
- Campus Kerckhoff, Justus-Liebig-University Gießen, Department of Rheumatology and Clinical Immunology, Gießen
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Bimba F. Hoyer
- Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Department of Rheumatology and Clinical Immunology, Kiel
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Hanns-Martin Lorenz
- University Hospital Heidelberg, Division of Rheumatology, Department of Medicine V, Heidelberg
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Alexander Pfeil
- University Hospital Jena, Department of Internal Medicine III, Jena
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Anne Regierer
- German Rheumatism Research Centre, Epidemiology Unit, Berlin
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Jutta Richter
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Department of Rheumatology and Hiller Research Unit, Düsseldorf
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Tim Schmeiser
- Private Practice Cologne, Köln
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Anja Strangfeld
- German Rheumatism Research Centre, Epidemiology Unit, Berlin
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Reinhard Voll
- University Medical Center – University of Freiburg, Faculty of Medicine, Department of Rheumatology and Clinical Immunology, Freiburg
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Christof Specker
- Kliniken Essen-Mitte, Department of Rheumatology and Clinical Immunology, Essen
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Hendrik Schulze-Koops
- University of Munich, Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, München
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Ulf Müller-Ladner
- Campus Kerckhoff, Justus-Liebig-University Gießen, Department of Rheumatology and Clinical Immunology, Gießen
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Andreas Krause
- Immanuel Hospital, Department of Rheumatology, Clinical Immunology and Osteology, Berlin
| Veröffentlicht: | 14. September 2021 |
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Gliederung
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Introduction: Patients with rheumatic and musculoskeletal diseases (RMD) might have an increased risk for infection due to their immunomodulatory treatment. The aim of this study was to assess courses of RMD-patients treated with TNF-inhibitors (TNF-I) included in the German COVID-19 registry.
Methods: In the German COVID-19-RMD registry, RMD-patients and confirmed SARS-CoV-2-infection were documented (data entered between March 30, 2020 and April 04, 2021). Among these patients, we analysed those treated with TNF-I, their course and outcome of infection. Data were compared to RMD-patients treated with other immunomodulatory drugs (OID) than TNF-I.
Results: A total of 483 patients were treated with a TNF-I (58% female) compared to 1524 patients who were treated with OID (70% female). Median age was 53 years in the TNF-I-group versus 59 years in the OID-group. Rheumatoid arthritis was the most common diagnosis (41% in TNF-I-group vs. 52% in the OID-group. Adalimumab (36%) and etanercept (36%) were the most frequently used TNF-I (Table 1 [Tab. 1]). Glucocorticoids (GC) were used in 19% of TNF-I-treated patients vs. 44% of the OID-group.
Under TNF-I, stable disease was reported prior to the SARS-CoV-2-infection in 53% of the patients (OID-group: 44%). Most frequent comorbidities was arterial hypertension (Table 1 [Tab. 1]).
The most common reported COVID-19 symptoms were dry cough (52% vs. 57%), fever (46% vs. 51%) and fatigue (54% vs. 51%). Hospitalization due to COVID-19 was required in only 10% of the TNF-I-treated cases vs. in 26% in the OID-group. Oxygen treatment was necessary in 6% of the patients under TNF-I compared to 20% under OID, invasive ventilation in 1% in the TNF-I-group compared to 6% under OID. Most notably, only one fatal course of COVID-19 was reported among the 483 RMD-patients (0.2%) treated with TNF-I versus 81 deaths in the 1524 cases (5.3%) treated with OID. Focussing on the hospitalized TNF-I patients, the rate of concomitant GC use (p<0.001) and disease activity (p=0.045) was significantly higher (Table 2 [Tab. 2]).
Conclusion: In this large cohort, RMD patients treated with TNF-I show a low hospitalisation rate and nearly no fatal courses. This is reassuring for patients and treating rheumatologists in using TNF-I to control disease activity. The use of glucocorticoids and high disease activity seem to act in the opposite direction of more severe courses of COVID-19.
Disclosures: None declared
