Compared with other commonly prescribed immunomodulatory regimens, treatment with tumor necrosis factor inhibitors (TNFis) was found to decrease the risk for adverse COVID-19 outcomes in patients with immune-mediated inflammatory diseases (IMIDs), according to study findings presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.
Researchers used data from 3 global COVID-19 registries to assess outcomes of COVID-19-related hospitalization or death associated with TNFi monotherapy among patients with IMIDs. The risk for hospitalization or death also was assessed among patients receiving treatment with other immunomodulatory regimens, including TNFis in combination with AZA/6-mercaptopurine (AZA/6MP), AZA/6MP monotherapy, methotrexate (MTX) monotherapy, and Janus kinase (JAK) inhibitor monotherapy.
Outcomes of COVID-19 and demographic and clinical characteristics were reported among patients with IMIDs with confirmed or suspected SARS-CoV-2 infection. Patients with resolved SARS-CoV-2 infection who were diagnosed with inflammatory arthritis, IBD, or psoriasis on or before February 1, 2021, were included in the current analysis.
The researchers performed individual and pooled analyses of data from 3 global COVID-19 registries, using multilevel multivariable mixed-effect logistic regression; adjustments were made for patients’ demographic and clinical characteristics, comorbidities, and concomitant immunomodulatory medications. In addition, the researchers performed a sensitivity analysis that excluded patients who were diagnosed with SARS-CoV-2 infection on the basis of symptoms alone.
A total of 6077 patients from 74 countries who were included in the analysis. The mean age of patients was 48.8±16.5 years; 58.6% were women; 35.3% had rheumatoid arthritis; and 25.3% had Crohn disease. In addition, 21.3% of patients were hospitalized due to COVID-19 and 3.1% died.
In the pooled analysis, the researchers found that risk for hospitalization was increased among patients who received treatment with TNFi monotherapy in combination with AZA/6MP (odds ratio [OR], 1.7; 95% CI, 1.2-2.6), AZA/6MP monotherapy (OR, 1.8; 95% CI, 1.3-2.6), MTX monotherapy (OR, 2.0; 95%CI, 1.6-2.6), or JAK inhibitor monotherapy (OR, 1.8; 95% CI, 1.2-2.7) compared with those who received treatment with TNFi monotherapy alone.
Of note, the researchers found that both individual and pooled analyses of data from the 3 global registries showed similar ORs among the included immunomodulatory regimens with regard to risk for hospitalization or death. In addition, similar findings were observed after excluding patients who were diagnosed with SARS-CoV-2 on the basis of symptoms alone.
“These [findings] can help inform treatment decisions for individuals with IMIDs during the [COVID-19] pandemic,” the researchers concluded.
Disclosure: Some authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.
Izadi Z, Brenner E, Mahil S, et al. TNF inhibitors and the risk of adverse COVID-19 outcomes in patients with immune-mediated inflammatory disease: pooled data from three global registries. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 0087.
This article originally appeared on Rheumatology Advisor