Background/Purpose: Information about the outcomes of patients with rheumatic disease with SARS-CoV-2 infection is scarce. Patients with rheumatic disease on immunosuppressive medications might represent a population at increased risk of SARS-CoV-2 infection or serious infection. Interestingly, few studies have suggested protective role of these drugs for COVID-19. We thus conducted a systematic review of studies reporting outcome of COVID-19 infection among patients with rheumatic diseases on biologic & targeted therapies.

Methods: We systematically searched PubMed/Medline and Scopus from January 1, 2020 to June 1, 2020 to identify studies that reported outcome of COVID-19 among patients with rheumatic disease. Demographic information, use of biologic (anti-TNF, IL-1, IL-6, IL-17, IL-12/IL-23, B cell, or T cell) or targeted therapy (Janus kinase inhibitor) were extracted from studies. The outcome measured was hospitalization, ICU admission, and death. Based on the clinical symptoms and need for hospitalization and ICU care, patients were grouped into severe (increased risk of respiratory failure or life-threatening complications) or non-severe.

Results: Our systematic review included eight observational cohort studies which comprised of 6095 patients with rheumatic disease. Of these, 123 patients (2%) were positive or highly suspicious for COVID-19 infection based on clinical features. The most common rheumatic diseases were rheumatoid arthritis (28%) and psoriatic arthritis (7%). The proportion of COVID-19 patients on biologics across all studies was 68%. The most common biologic agent was anti-TNF agents (31%). The percentage of users of JAK inhibitors was 6%. Among those with SARS-COV2 infection, 91 patients (73%) were not hospitalized. Among those hospitalized, 13 patients (11% of total) required ICU admission and 4 patients died (3.2% of total).

Conclusion: In this systematic review, the incidence of COVID-19 infection was low in patients with rheumatic disease. The majority had a mild clinical course and case fatality was low.  However, larger cohort studies are necessary to examine outcomes of COVID-19 among biologic and non-biologic users. Furthermore, factors such as disease severity index and duration of biologic & targeted therapy use need to be considered in future studies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/covid-19-infection-among-patients-with-rheumatic-disease-on-biologic-targeted-therapies-a-systematic-review/