Rituximab or JAKi therapies in rheumatoid arthritis increase the risk of severe COVID-19

Severe COVID-19 outcomes risk in RA patients is 4 times higher for rituximab, and 2 times higher for JAK inhibitor users compared to TNF inhibitor users. This was not found for abatacept or IL-6-inhibiting DMARDs.

Rituximab or JAK inhibitor use at COVID-19 onset resulted more often in hospitalisation with oxygen or ventilation

The risk of severe COVID-19 outcomes in patients with rheumatoid arthritis (RA) is 4 times higher for rituximab users and 2 times higher for JAK inhibitor users compared with TNF inhibitor users. This association was not found for abatacept and IL-6-inhibiting DMARDs. This was concluded from a large study comparing COVID-19 severity in RA patients on different classes of DMARDs. These results demonstrated the importance of risk-mitigation strategies in RA patients on rituximab or JAK inhibitors.

To examine the effect of baseline use of different DMARD classes on COVID-19 severity in RA, 2,869 patients with resolved COVID-19 were selected from the global rheumatology alliance physician registry. Treatment with rituximab, JAK inhibitors, abatacept, or IL-6 inhibitors was compared with TNF inhibitors (reference group) on an ordinal COVID-19 severity scale (1: not hospitalised; 2: hospitalised without oxygen; 3: hospitalised with oxygen or ventilation; 4: death).

85.4% of TNF inhibitor users were not hospitalised as a consequence of COVID-19

Data was analysed via ordinal logistic regression analysis. The results demonstrated that patients treated with rituximab or JAK inhibitors had a 4-fold or 2-fold increased risk of severe COVID-19 outcomes, respectively, compared with the reference group. In 85.4% of the cases, TNF inhibitor users were not hospitalised as a consequence of COVID-19. These percentages were significantly smaller in patients on rituximab (57.7%) or JAK inhibitors (72.6%).

Baseline users of abatacept or IL-6 inhibitors were not hospitalised in 76.4% and 85.5% of the cases. In addition, rituximab or JAK inhibitor use at COVID-19 onset resulted more often in hospitalisation with oxygen or ventilation (rituximab 22.0%; JAK inhibitors 15.3%; TNF inhibitors 7.4%) or death (rituximab 14.8%; JAK inhibitors 7.1%; TNF inhibitors 2.6%) than TNF inhibitor use. Dr Jeffrey Sparks (Brigham and Women’s Hospital, USA), who presented the results of this study, stressed the importance of COVID-19 risk management in RA patients on rituximab or JAK inhibitors, such as prioritising them for vaccination. 

Source:
Associations of Baseline Use of Biologic or Targeted Synthetic DMARDs with COVID-19 Severity in Rheumatoid Arthritis: Results from the COVID-19 Global Rheumatology Alliance Physician Registry. OP0006, EULAR 2021 Virtual Congress, 2-5 June.