Previous studies have observed that there is no elevated risk for COVID-19 in patients with inflammatory rheumatic diseases (IRD) compared to the general population, but it remains unclear whether IRD patients are on anti-rheumatic drugs (ARD) are at risk as opposed to other patients with IRD. A recent multicentre, nested case-control study published in Clinical Pharmacology & Therapeutics has reported that the IRD or the use of specific ARD does not increase the risk for COVID-19 hospitalization. However, the risk for hospitalization is significantly higher in elderly and obese IRD patients and it is comparable to that of the general population.
The study carried out at four rheumatology centers in the Netherlands compared the data of hospital known IRD patients requiring hospitalization for COVID (81) with the hospital known IRD patients not requiring hospitalization (controls, 396) during the same period. The use of an antirheumatic agent or IRD was not associated with increased risk for COVID-19 hospitalization. Moreover, the use of methotrexate conferred a protective effect against severe COVID-19 (OR 0.53, 95% CI 0.31-0.92).
Opdam et al., in the present study, has concluded that the elderly and obese IRD population, are considered at high risk for COVID-19 hospitalization. The high risk for COVID-19 hospitalization was not identified in ARD patients, and interestingly, they found that methotrexate use may have a protective effect against COVID-19 hospitalization.
Similarly, a recent review by Silva et al. concluded that the use of different classes of DMARDs is not associated with increased risk for severe COVID-19; whereas, baseline glucocorticoid use is linked to adverse outcomes. The present study provides reassuring clinical evidence to both patients and medical personnel regarding the use of antirheumatic drugs in IRD patients who are at risk for COVID-19. In addition, the protective effect conferred by methotrexate opens new avenue for clinical research in the field of rheumatology.
Opdam MAA, Benoy S, Verhoef LM, et al. Identification of risk factors for COVID-19 hospitalization in patients with anti-rheumatic drugs: results from a multicentre nested case-control study [published online ahead of print, 2022 Feb 10]. Clin Pharmacol Ther. 2022;10.1002/cpt.2551.
D’Silva KM, Wallace ZS. COVID-19 and Disease-Modifying Anti-rheumatic Drugs. Curr Rheumatol Rep. 2021;23(5):28. Published 2021 Apr 24. doi:10.1007/s11926-021-00998-9