Use of Biologic Treatment and Risk to Be Admitted for COVID-19 Infection

Carlos González¹, Luis Menchén¹, Indalecio Monteagudo¹, Ofelia Baniandrés², Juan Carlos Nieto Gonzalez¹, Ignacio Marín-Jiménez¹, Ana Herranz-Alonso¹, Carmen Lobo-Rodríguez¹, Amparo López-Esteban¹, Ana López¹, Arantza Ais-Larisgoitia¹, Esther Chamorro de Vega¹, Paloma Morales de los Ríos¹, Maria Jesús Lizcano¹, Jose Maria Alvaro-Gracia¹ and Sonia García de San-José¹, ¹CEIMI, Hospital General Universitario Gregorio Marañón, Madrid, Spain, ²CEIMI, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain

Meeting: ACR Convergence 2020

Keywords: Biologicals, COVID-19, Managed Care

Session Information

Date: Saturday, November 7, 2020

Session Title: Infection-related Rheumatic Disease Poster

Session Type: Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: To analyze the risk of admission for COVID19 infection and outcome of patients treated with b/tsDMARD from our center, to compare with all patients admitted for COVID-19 infection.

Methods: Records of the b/tsDMARD patients admitted for COVID-19 infection between March 8 and June 8, 2020 were analyzed retrospectively. Age, gender, and outcome of all patients admitted to our hospital for COVID19 infection on the same dates were collected. Chi-square, Student’s t and Man-Whitney U tests were used when appropriate.

Results: 1,668 patients with IMID treated with b/tsDMARD were included. Median age 53.0 years (range 17-91), 52.4% women. Diagnoses and DMARD distribution are shown in tables 1 and 2. 21/1668 (1.3%; 4.2/100 patient-years) were admitted for severe COVID19 infection. Mortality ratio: 4/21 (19.0%). Median age of the admitted patients was higher: 61.0y (SD 14.7) vs 53.0y (SD 15.0); p < 0.006. Median age of deceased patients was also higher 69.5y (SD 20.3) vs 53.0y (SD 15.0); p: NS. Female gender had a worse prognosis trend: 52.4% of all group, 61.9% of those hospitalized, 75.0% of those who died. Females had a higher median age than men: 55.0y (SD 14.9) vs. 50.0y (SD 14.9); p < 0.001.

When comparing patients treated with DMARD admitted for COVID19 infection with all patients hospitalized for the same reason (2,684 patients), no differences were found neither in age (61.0y [SD 14.7] vs 60.0y [SD 19.0]; NS) nor gender (female: 61.9% vs 50.2%; NS). Mortality rate was not different: 4/21 (21.0%) vs 551/2684 (20.5%); p: NS, but patients treated with b/tsDMARD died at a younger age: 69.5y (SD 20.3) vs 81.5 (SD 11.3); p: NS.

Rheumatoid arthritis patients were admitted more frequently: (9/392 (2.3%) vs 12/1276 (0.9%); p < 0.035. And were older: median 62y (SD 13.5) vs 50.0y (SD 14.4); p < 0.001.

Patients treated with anti-TNF suffered less admissions: 6/1055 (0.6%) vs 15/613 (2.4%); p< 0.001 and were younger: median 51.0y (SD 15.0) vs 55.0y (SD 14.7); p < 0.001. Anti-TNF were less used in patients with rheumatoid arthritis 188/392 (48.0%) vs 867/1276 (67.9%); p< 0.001. Table 1:

Disease

N (%)

Admitted

deaths

Rheumatoid arthritis

Spondylarthritis

Psoriatic arthritis

JIA

CTD

Vasculitis

IBD

Psoriasis

others

392 (23.5%)

277 (16.6%)

124 (7.4%)

30 (1.8%)

31 (1.9%)

20 (1.2%)

582 (34.9%)

202 (12.1%)

10 (0.6%)

9/392 (2.3%)

3/277 (1.1%)

1/124 (0.8%)

0/30 (0.0%)

1/31 (3.2%)

0/20 (0.0%)

4/578 (0.7%)

3/202 (1.5%)

0/10 (0.0%)

TOTAL

1,668 (100%)

21/1668 (1.3%)

4/21 (19.0%)

Table 2:

Treatment

N (%)

Admitted

deaths

Anti-TNF

Anti-CD20

Anti-IL6

CTLA4-Ig

Anti-IL17

Anti-IL12/23

Anti-integrin

JAK inhibitor

PDE4 inhibitor

Anti-IL23

1055 (63.2%)

79 (4.7%)

96 (5.8%)

44 (2.6%)

92 (5.5%)

143 (8.6%)

79 (4.7%)

34 (2.0%)

32 (1.9%)

14 (0.8%)

6/1055 (0.6%)

3/79 (3.8%)

3/96 (3.1%)

3/44 (6.8%)

3/92 (3.3%)

1/143 (0.7%)

0/79 (0.0%)

1/34 (2.9%)

1/32 (3.1%)

0/14 (0.0%)

TOTAL

1,668 (100%)

21/1668 (1.3%)

4/21 (19.0%)

Conclusion: It is reasonable that patients with inflammatory diseases treated with b/tsDMARD continue their treatment during the COVID19 epidemic. The different rates of hospitalization based on the diagnosis or DMARD may be due to comorbidity, confounding by indication and other bias. The study is not powerful enough to study these confounders.

Disclosure: C. González, Abbvie, 8, Celgene, 8, Gilead, 5, 8, Janssen, 5, 8, novartis, 5, 8, Pfizer, 8, Roche, 8, Merck, 5; L. Menchén, Abbvie, 2, 5, 8, Janssen, 2, 5, 8, Takeda, 2, 5, 8, Merck, 2, 5, 8, Medtronic, 5, Tillots, 5, 8, Pfizer, 5, 8; I. Monteagudo, None; O. Baniandrés, None; J. Nieto Gonzalez, None; I. Marín-Jiménez, Abbvie, 5, 8, Chiesi, 5, 8, FAES, 5, 8, Otsuka, 5, 8, Merck, 5, 8, Janssen, 5, 8, Hospira, 5, 8, Gebro, 5, 8; A. Herranz-Alonso, None; C. Lobo-Rodríguez, None; A. López-Esteban, None; A. López, None; A. Ais-Larisgoitia, None; E. Chamorro de Vega, None; P. Morales de los Ríos, None; M. Lizcano, None; J. Alvaro-Gracia, Abbvie, 2, 5, 8, lilly, 2, 5, 8, Merck, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 5, 8, UCB, 5, 8, Sanofi, 5, 8; S. García de San-José, None.

To cite this abstract in AMA style:

González C, Menchén L, Monteagudo I, Baniandrés O, Nieto Gonzalez J, Marín-Jiménez I, Herranz-Alonso A, Lobo-Rodríguez C, López-Esteban A, López A, Ais-Larisgoitia A, Chamorro de Vega E, Morales de los Ríos P, Lizcano M, Alvaro-Gracia J, García de San-José S. Use of Biologic Treatment and Risk to Be Admitted for COVID-19 Infection [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/use-of-biologic-treatment-and-risk-to-be-admitted-for-covid-19-infection/. Accessed April 12, 2021.

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