EULAR Report: Steroid Use Linked to More Severe COVID-19 Cases

June 4, 2020

Rheumatic disease patients treated with anti-TNF therapy and who contracted COVID-19, were hospitalized less often than patients treated with glucocorticoids, shows an observational study presented on Wednesday at the European Congress of Rheumatology (EULAR) annual meeting-which is being held virtually this week from the homes of more than 18,000 registered attendees.

Rheumatic disease patients treated with anti-TNF therapy and who contracted COVID-19, were hospitalized less often than patients treated with glucocorticoids, shows an observational study presented on Wednesday at the European Congress of Rheumatology (EULAR) annual meeting-which is being held virtually this week from the homes of more than 18,000 registered attendees.

The meeting, which was to be held in Germany, includes more than three dozen studies on outcomes associated with COVID-19 infections and on the effectiveness of treatments that are traditionally used to treat rheumatic disease.

In this study, which was published May 29 in the Annals of the Rheumatic Diseases, Dr. Pedro Machado and his team analyzed data from the EULAR and COVID-19 Global Rheumatology Alliance registries. The registries are tracking the outcomes of COVID-19 infections in rheumatic disease patients from throughout the world.

This study included 600 patients from 40 countries in which nearly half of patients were hospitalized and 9% died. Researchers found that patients who were receiving a prednisone dose of more than 10 mg per day were hospitalization at higher rates. The use of conventional disease-modifying antirheumatic drugs (DMARD) alone, or in combination with biologics or JAK inhibitors, was not associated with hospitalization status nor was the use of non-steroidal anti-inflammatory drugs (NSAIDs).

Patients who whose rheumatic disease was being treated with tumor necrosis factor inhibitors (anti-TNF) had a reduced odds of hospitalization, while there was no association found with antimalarial use.

Researchers throughout the world are trying to determine if immunosuppressants increase the risk of a severe disease in due to a SARS-CoV-2 infection, or whether it could possible offer a protective affect.

"There is considerable uncertainty about the drug management in the context of rheumatic conditions," said Dr. Iain B. McInnes, EULAR president.

Dr. Machado stated that the findings are observational only and do not reflect a true rate of hospitalization or death among patients with rheumatic disease who are infected with SARS-CoV-2.

The registry most likely leans toward recording severe cases of COVID-19 infection, over mild and moderate cases, particularly asymptomatic and in doing so, this may artificially increase the rates of hospitalization and death in this study group.

But ultimately, "the study shows that most patients with rheumatological conditions recover from COVID-19-independent of the medication they receive," said Dr. John Isaacs, of the University of Newcastle and scientific chair of the EULAR Scientific Committee. "It is necessary, however, to gather more knowledge about the course of an infection with the novel coronavirus in patients with inflammatory rheumatic conditions."

REFERENCE: Gianfrancesco M, Hyrich KL, Al-Adely S, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Annals of the Rheumatic Diseases. Published Online First: 29 May 2020. doi: 10.1136/annrheumdis-2020-217871