Dr. Zara Izadi of the University of California, San Francisco, and colleagues evaluated data on 6,077 COVID-19 patients with IMIDs who were treated with a TNFi alone, a TNFi in combination with either methotrexate or azathioprine/6-mercaptopurine, or standalone monotherapy with either methotrexate, azathioprine/6-mercaptopurine or a Janus kinase (Jak) inhibitor.
RA and Crohn's disease were the predominant diagnoses, followed by ulcerative colitis, spondyloarthritis, psoriasis and unspecified inflammatory bowel disease.
In the pooled analysis, compared with patients on TNFi monotherapy, the odds of hospitalization or death were significantly higher for patients who received a TNFi plus azathioprine/6-mercaptopurine therapy (odds ratio, 1.74; 95% confidence interval, 1.17 to 2.58), azathioprine/6-mercaptopurine monotherapy (OR, 1.84; 95% CI, 1.30-2.61), methotrexate monotherapy (OR, 2.00; 95% CI,s 1.57 to 2.56), and Jak inhibitor monotherapy (OR, 1.82; 95% CI, 1.21 to 2.73) but not among those who received a TNFi plus methotrexate (OR, 1.18; 95% CI, 0.85 to 1.63).
In line with prior studies, the presence of obesity, diabetes, cardiovascular disease, lung disease, and chronic kidney disease were all associated a higher risk of hospitalization or death.
"These findings support the continued use of TNF inhibitor monotherapy during the pandemic and warrant further research investigating the association of other biologic therapies with COVID-19 outcomes," Dr. Izadi and colleagues write in JAMA Network Open.
In a linked editorial, Dr. Licio A. Velloso of the University of Campinas, in Sao Paulo, Brazil, says COVID-19 has created "questions regarding both the safety and potential therapeutic applicability of several anti-inflammatory agents, including TNF inhibitors."
One of the greatest strengths of this study is the inclusion of a large number of patients with distinct ethnic backgrounds and IMIDs. Based on the findings, "the evidence in favor of the continued use of TNF inhibitor monotherapy for patients with IMIDs during the COVID-19 pandemic has become more substantial," Dr. Velloso writes.
"The finding that maintenance of TNF inhibitor monotherapy is associated with reductions in the risk of severe COVID-19 among patients with IMIDs offers new perspective that may guide health care professionals in the difficult decisions regarding therapeutic approaches among this specific group of patients," Dr. Velloso says.
The study had no commercial funding.
SOURCE: https://bit.ly/3aNOt1s and https://bit.ly/3lS6PVF JAMA Network Open, online October 18, 2021.
By Reuters Staff
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