Effects of rheumatic drugs on COVID-19 progression

1.5 years since the beginning of the Corona pandemic, many questions remain for patients with rheumatic and musculoskeletal diseases (RMD) concerning the influence of anti-rheumatic drugs on the course of COVID-19 disease.

Certain drugs used to treat RMDs are known to alter the immune system and therefore influence the patients’ susceptibility to infections. Two epidemiologists from the German Rheumatism Research Centre, Anne Regierer and Martin Schäfer, in close collaboration with Rebecca Hasseli, coordinator of the COVID19-Arthritis Register of the Deutsche Gesellschaft für Rheumatologie (DGRh) conducted a study to identify which risk factors could lead to a more severe course of SARS-CoV-2 infection. They analysed data from 2,274 patients in the German COVID-19-RMD registry, collected since March 2020. A large majority (78%) of RMD patients had an uncomplicated course of infection and could be treated as outpatients. However, 3.6% of RMD patients died of COVID-19.

Regarding the effect of drugs on the disease course, the researchers found that while TNF inhibitors were associated with a milder course of COVID-19 disease, JAK inhibitors and rituximab were associated with a severer course of SARS-CoV2 infection. Immunosuppressants such as mycophenolate, azathioprine, cyclophosphamide and ciclosporin are also associated with a more severe course.

However, the most important objective remains the control of disease activity, because patients with moderate to high rheumatic disease activity have a significantly higher risk of a more severe course of COVID-19. Therefore, medication should not be discontinued. Therapeutic decisions must be carefully considered, so that the best possible control of the rheumatic disease can be achieved with the lowest possible risk of infection. This also includes consistent information about vaccination and ensuring the highest possible vaccination rate among patients.