Case Report: Biologics Not Associated With Worse COVID-19 Outcomes

Physicians from New York University Langone Health report in the New England Journal of Medicine that the baseline use of biologics was not associated with worse outcomes in a group of 14 patients with autoimmune disease who contracted COVID-19.

The authors of the case series included Jose U. Scher, M.D., a rheumatologist at New York University Langone Health. He and his colleagues reported cases of patients with COVID-19 or suspected symptomatic COVID-19 and also either rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, inflammatory bowel disease, or other immune-mediated inflammatory disease. These patients were receiving long-term biologic therapy, other immunomodulators or both.

The series included 86 patients in total:  59 had a confirmed COVID-19 infection and 27 had a highly suspected symptomatic COVID-19 infection. 62 of these patients were receiving biologics or a Janus kinase (JAK) inhibitors. 76 percent of 14 of 86 patients were hospitalized patients and these were generally older patients with rheumatoid arthritis with comorbidities, such as hypertension, diabetes, or chronic obstructive pulmonary disease. 11 of the patient were eventually discharged after nearly 6 days in in-hospital, and two remained hospitalized at the time of the writing of the writing in the journal. One of the two patients had elevated interleukin-6 levels and received mechanical ventilation for acute respiratory distress syndrome, and the other died in the emergency department, however, neither of these patients were receiving long-ter biologic therapies.

"The percentage of patients who were receiving biologics or JAK inhibitors at baseline was higher among the ambulatory patients than among the hospitalized patients (55 of 72 patients [76%] and 7 of 14 patients [50%], respectively), and the overall incidence of hospitalization among patients who had received these medications on a long-term basis was 11% (7 of 62 patients). However, even after multivariate analysis, the use of oral glucocorticoids (in 4 of 14 hospitalized patients [29%] and in 4 of 72 ambulatory patients [6%]), hydroxychloroquine (in 3 of 14 patients [21%] and 5 of 72 patients [7%], respectively), and methotrexate (in 6 of 14 patients [43%] and 11 of 72 patients [15%], respectively) was higher among patients with immune-mediated inflammatory disease for whom hospitalization was warranted. These observations were consistent when the analysis was restricted to patients with confirmed SARS-Cov-2 infection on polymerase-chain-reaction testing," the authors wrote.

REFERENCE:  "Covid-19 in Immune-Mediated Inflammatory Diseases - Case Series from New York," New England Journal of Medicine. April 29, 2020. DOI: 10.1056/NEJMc2009567