Session Type: Poster Session A
Session Time: 8:30AM-10:30AM
Background/Purpose: While tumor necrosis factor inhibitors (TNFi) are widely prescribed globally due to their high efficacy across immune-mediated inflammatory diseases (IMIDs), the impact of COVID-19 on individuals with IMIDs receiving TNFi remains poorly understood. The objective of this study was to assess the association between TNFi monotherapy and COVID-19-related hospitalization or death among individuals with IMIDs, compared to other commonly prescribed immunomodulatory regimens.
Methods: We used data from three global COVID-19 registries of individuals with rheumatic diseases, IBD, and psoriasis. Healthcare providers reported COVID-19 outcomes and demographic and clinical characteristics of individuals with IMIDs with confirmed or suspected COVID-19. We included resolved adult COVID-19 cases with a diagnosis of inflammatory arthritis (IA), IBD, or psoriasis reported on or before February 1st, 2021. Medication exposure was defined as a categorical variable with the following categories: TNFi monotherapy (reference), TNFi in combination with MTX, TNFi in combination with AZA/6-mercaptopurine (AZA/6MP), MTX monotherapy, AZA/6MP monotherapy, and janus kinase inhibitor (JAKi) monotherapy. The outcome was COVID-19-related hospitalization or death. Registry-level analyses and a pooled analysis of data across the three registries were conducted using multilevel multivariable mixed-effects logistic regression, adjusting for demographics, clinical characteristics, comorbidities, concomitant immunomodulatory medications, and accounting for country, calendar-month, and registry-level correlations. In a sensitivity analysis we excluded patients whose COVID-19 diagnosis was based on symptoms alone.
Results: A total of 6,077 cases from 74 countries were included. Mean (SD) age was 48.8 (16.5) years and 58.6% were female (Table). The most common diagnoses were rheumatoid arthritis (35.3%) and Crohn’s disease (25.3%). Over one-fifth (21.3%) of cases were hospitalized for COVID-19 and 3.1% died. In the pooled analysis, compared with TNFi monotherapy, higher odds of hospitalization or death were observed with TNFi in combination with AZA/6MP (odds ratio: 1.7, 95% CI: 1.2-2.6), AZA/6MP monotherapy (1.8, 1.3-2.6), MTX monotherapy (2.0, 1.6-2.6), and JAKi monotherapy (1.8, 1.2-2.7). ORs obtained from registry-specific analyses were generally in the same direction and of similar magnitude as those obtained from the pooled analysis (Figure). Similar findings were obtained after excluding patients whose COVID-19 diagnosis was based on symptoms alone.
Conclusion: Among individuals with IMIDs, TNFi monotherapy is associated with a lower risk of adverse COVID-19 outcomes compared with other commonly prescribed immunomodulatory regimens. These data can help inform treatment decisions for individuals with IMIDs during the pandemic.
To cite this abstract in AMA style:Izadi Z, Brenner E, Mahil S, Dand N, Yiu Z, Yates M, Ungaro R, Zhang X, Agrawal M, Colombel J, Gianfrancesco M, Hyrich K, Strangfeld A, Carmona L, Frazão Mateus E, Lawson-Tovey S, Klingberg E, Cuomo G, Caprioli M, FLIPO R, Cruz-Machado A, Mazeda C, Hasseli R, Pfeil A, Lorenz H, Trupin L, Rush S, Katz P, Schmajuk G, Jacobsohn L, Seet A, Al Emadi S, Wise L, Gilbert E, Duarte-Garcia A, Valenzuela-Almada M, Isnardi C, Quintana R, Soriano E, Hsu T, D'Silva K, Sparks J, Patel N, de Souza V, Mota L, Reis A, Wallace Z, Bhana S, Costello W, Grainger R, Hausmann J, Liew J, Sirotich E, Sufka P, Robinson P, Machado P, Griffiths C, Barker J, smith C, Yazdany J, Kappelman M. TNF Inhibitors and the Risk of Adverse COVID-19 Outcomes in Patients with Immune-Mediated Inflammatory Disease: Pooled Data from Three Global Registries [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/tnf-inhibitors-and-the-risk-of-adverse-covid-19-outcomes-in-patients-with-immune-mediated-inflammatory-disease-pooled-data-from-three-global-registries/. Accessed December 5, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tnf-inhibitors-and-the-risk-of-adverse-covid-19-outcomes-in-patients-with-immune-mediated-inflammatory-disease-pooled-data-from-three-global-registries/