Associations of DMARDs with post-acute sequelae of COVID-19 in patients with systemic autoimmune rheumatic diseases: a prospective study,2023,Venkat+

Associations of DMARDs with post-acute sequelae of COVID-19 in patients with systemic autoimmune rheumatic diseases: a prospective study
Venkat, Rathnam K; Wang, Xiaosong; Patel, Naomi J; Kawano, Yumeko; Schiff, Abigail; Kowalski, Emily N; Cook, Claire E; Vanni, Kathleen M M; Qian, Grace; Bade, Katarina J; Saavedra, Alene; Srivatsan, Shruthi; Williams, Zachary K; Wallace, Zachary S; Sparks, Jeffrey A

Objective: We investigated the baseline disease-modifying antirheumatic drug (DMARD) use and post-acute sequelae of COVID-19 (PASC) risk among patients with systemic autoimmune rheumatic diseases (SARDs).

Methods: Patients with SARDs and confirmed COVID-19 infection at Mass General Brigham completed a survey ≥28 days after positive PCR/Antigen test to prospectively investigate their COVID-19 courses. We investigated DMARD use at COVID-19 onset and PASC risk. PASC was defined as any COVID-19 symptom that persisted for ≥28 days. We used logistic regression to estimate odds ratios (OR) for PASC by DMARD class. We also used restricted mean survival time to determine the difference in symptom-free days by DMARD class in the 28-day period after infection.

Results: We analyzed 510 patients with SARDs and COVID-19 from 11/Mar/2021 to 17/Jun/2023; 202 (40%) developed PASC. CD20 inhibitor (CD20i) users had significantly higher odds of developing PASC vs. csDMARD users (adjusted OR 2.69, 95%CI 1.23-5.88). IL-12/23, IL-17A, or IL-23 inhibitor (IL-12/23i, IL-17Ai, IL-23i) users also had significantly higher odds of PASC (adjusted OR 3.03, 95%CI 1.08-8.49). CD20i users had significantly fewer symptom-free days vs. csDMARD users (adjusted -4.12, 95%CI -7.29 to -0.94).

Conclusion: CD20i users had significantly higher odds of PASC and fewer symptom-free days over the 28 days following COVID-19 diagnosis compared to csDMARD users. Further research is needed to investigate whether PASC risk in CD20i users may be due to prolonged infection or other immune mechanisms. The association of IL-12/23i, IL-17Ai, and IL-23i and PASC calls for additional study.

KEY MESSAGES

• CD20i and IL-12/23i, IL-17Ai, and IL-23i users had significantly higher odds of PASC vs. csDMARD users.

• CD20i users had fewer symptom-free days in the month after COVID-19 diagnosis vs. csDMARD users.

• When possible, providers should exercise caution when prescribing CD20i to patients with SARDs.

Link | Paywall (Rheumatology)