Biologic Treatment Recommendations for Rheumatic Disease Patients Who Contract COVID-19

Editor’s note: EULAR 2020, the annual European congress of rheumatology, which was originally scheduled to be held in Frankfurt, Germany, starting June 3, was moved to a virtual format due to the COVID-19 pandemic.

EULAR 2020 e-CONGRESS—Early data on COVID-19 infection and hospitalization are reassuring regarding the safety of biologic therapy, and patients should generally be kept on the therapies, according to experts at the European e-congress of rheumatology. The assessments come from databases that have been assembled in Europe by researchers working quickly to get a portrait of patients with rheumatic diseases infected by SARS-CoV-2.

The European League Against Rheumatism (EULAR) database and the Global Database, being led by researchers in the U.S. and Australia, are both part of the COVID-19 Global Rheumatology Alliance database—an ACR-supported effort to assemble data from around the world, said Kimme Hyrich, MD, PhD, professor of epidemiology, University of Manchester, U.K., and a researcher in the Centre for Epidemiology Versus Arthritis, who has helped coordinate the EULAR registry.

Dr. Hyrich said the Global Alliance registry had collected data on more than 1,800 patients through the third week of May. The data are coming from case information being directly entered into the registry and from national registries that have been put together across Europe.

Dr. Hyrich mentioned two cases with very different outcomes to illustrate the vexing nature of COVID-19 and the need to identify useful patterns. A 38-year-old woman with lupus nephritis was taking hydroxychloroquine, azathioprine, belimumab and steroids. Once infected with SARS-CoV-2, she had a severe course of pneumonitis, requiring intubation, renal failure and a prolonged intensive care unit stay. The other case was a 45-year-old man with spondyloarthritis and inflammatory bowel disease who was taking adalimumab and budesonide. He had an incidental positive COVID-19 test, but showed no symptoms.

“We need a way to rapidly capture the experience and outcome among patients with rheumatic diseases who acquire this infection,” Dr. Hyrich said. She acknowledged there is a high likelihood of bias, because a lack of community testing means asymptomatic and mild cases will be missed; and the full number of the at-risk population is not known, meaning researchers can’t draw conclusions about incidence or cause and effect of individual medications or diseases.

Study Results
Based on an analysis of data from 600 patients from 40 countries in the Global Alliance database, those on biologic disease-modifying anti-rheumatic drugs (DMARDs) or targeted synthetic DMARDs had a 50% lower chance of hospitalization compared with those not on a DMARD.¹