Risk of severe COVID-19 in patients with inflammatory rheumatic diseases treated with immunosuppressive therapy in Scotland

P. M. McKeigue; D. Porter; R. J. Hollick; S. H. Ralston; D. A. McAllister; H. M. Colhoun

doi:10.1080/03009742.2022.2063376

Risk of severe COVID-19 in patients with inflammatory rheumatic diseases treated with immunosuppressive therapy in Scotland

P. M. McKeigue^*, D. Porter, R. J. Hollick, S. H. Ralston, D. A. McAllister, H. M. Colhoun

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Objective: To investigate the association of severe coronavirus disease 2019 (COVID-19) in patients with inflammatory rheumatic diseases (IRDs) treated with immunosuppressive drugs. Method: A list of 4633 patients on targeted–biological or targeted synthetic–DMARDs in March 2020 was linked to a case–control study that includes all cases of COVID-19 in Scotland. Results: By 22 November 2021, 433 of the 4633 patients treated with targeted DMARDS had been diagnosed with COVID-19, of whom 58 had been hospitalized. With all those in the population not on DMARDs as the reference category, the rate ratio for hospitalized COVID-19 associated with DMARD treatment was 2.14 [95% confidence interval (CI) 2.02–2.26] in those on conventional synthetic (cs) DMARDs, 2.01 (95% CI 1.38–2.91) in those on tumour necrosis factor (TNF) inhibitors as the only targeted agent, and 3.83 (95% CI 2.65–5.56) in those on other targeted DMARDs. Among those on csDMARDs, rate ratios for hospitalized COVID-19 were lowest at 1.66 (95% CI 1.51–1.82) in those on methotrexate and highest at 5.4 (95% CI 4.4–6.7) in those on glucocorticoids at an average dose > 10 mg/day prednisolone equivalent. Conclusion: The risk of hospitalized COVID-19 is elevated in IRD patients treated with immunosuppressive drugs compared with the general population. Of these drugs, methotrexate, hydroxychloroquine, and TNF inhibitors carry the lowest risk. The highest risk is associated with prednisolone. A larger study is needed to estimate reliably the risks associated with each class of targeted DMARD.

Original language	English
Pages (from-to)	412-417
Number of pages	6
Journal	Scandinavian Journal of Rheumatology
Volume	52
Issue number	4
Early online date	12 May 2022
DOIs	https://doi.org/10.1080/03009742.2022.2063376
Publication status	Published - Jul 2023

Bibliographical note

Funding Information:
No specific funding was received for this study. We thank Jen Bishop, Ciara Gribben, and David Caldwell for undertaking the linkage analysis in Public Health Scotland, and staff from the rheumatology service in the contributing centres for preparing the list of patients receiving these treatments.

Data Availability Statement

The component data sets used here are available via the Public Benefits and Privacy Panel for Health and Social Care at https://www.informationgovernance.scot.nhs.uk/pbpphsc/ for researchers who meet the criteria for access to confidential data. All source code used for derivation of variables, statistical analysis, and generation of this manuscript is available at https://github.com/pmckeigue/covid-scotland_public.

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McKeigue_etal_SJoR_Risk_of_Severe_VOR
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
Final published version, 566 KBLicence: CC BY-NC-ND

Cite this

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title = "Risk of severe COVID-19 in patients with inflammatory rheumatic diseases treated with immunosuppressive therapy in Scotland",

abstract = "Objective: To investigate the association of severe coronavirus disease 2019 (COVID-19) in patients with inflammatory rheumatic diseases (IRDs) treated with immunosuppressive drugs. Method: A list of 4633 patients on targeted–biological or targeted synthetic–DMARDs in March 2020 was linked to a case–control study that includes all cases of COVID-19 in Scotland. Results: By 22 November 2021, 433 of the 4633 patients treated with targeted DMARDS had been diagnosed with COVID-19, of whom 58 had been hospitalized. With all those in the population not on DMARDs as the reference category, the rate ratio for hospitalized COVID-19 associated with DMARD treatment was 2.14 [95% confidence interval (CI) 2.02–2.26] in those on conventional synthetic (cs) DMARDs, 2.01 (95% CI 1.38–2.91) in those on tumour necrosis factor (TNF) inhibitors as the only targeted agent, and 3.83 (95% CI 2.65–5.56) in those on other targeted DMARDs. Among those on csDMARDs, rate ratios for hospitalized COVID-19 were lowest at 1.66 (95% CI 1.51–1.82) in those on methotrexate and highest at 5.4 (95% CI 4.4–6.7) in those on glucocorticoids at an average dose > 10 mg/day prednisolone equivalent. Conclusion: The risk of hospitalized COVID-19 is elevated in IRD patients treated with immunosuppressive drugs compared with the general population. Of these drugs, methotrexate, hydroxychloroquine, and TNF inhibitors carry the lowest risk. The highest risk is associated with prednisolone. A larger study is needed to estimate reliably the risks associated with each class of targeted DMARD.",

author = "McKeigue, {P. M.} and D. Porter and Hollick, {R. J.} and Ralston, {S. H.} and McAllister, {D. A.} and Colhoun, {H. M.}",

note = "Funding Information: No specific funding was received for this study. We thank Jen Bishop, Ciara Gribben, and David Caldwell for undertaking the linkage analysis in Public Health Scotland, and staff from the rheumatology service in the contributing centres for preparing the list of patients receiving these treatments. ",

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T1 - Risk of severe COVID-19 in patients with inflammatory rheumatic diseases treated with immunosuppressive therapy in Scotland

AU - McKeigue, P. M.

AU - Porter, D.

AU - Hollick, R. J.

AU - Ralston, S. H.

AU - McAllister, D. A.

AU - Colhoun, H. M.

N1 - Funding Information: No specific funding was received for this study. We thank Jen Bishop, Ciara Gribben, and David Caldwell for undertaking the linkage analysis in Public Health Scotland, and staff from the rheumatology service in the contributing centres for preparing the list of patients receiving these treatments.

PY - 2023/7

Y1 - 2023/7

N2 - Objective: To investigate the association of severe coronavirus disease 2019 (COVID-19) in patients with inflammatory rheumatic diseases (IRDs) treated with immunosuppressive drugs. Method: A list of 4633 patients on targeted–biological or targeted synthetic–DMARDs in March 2020 was linked to a case–control study that includes all cases of COVID-19 in Scotland. Results: By 22 November 2021, 433 of the 4633 patients treated with targeted DMARDS had been diagnosed with COVID-19, of whom 58 had been hospitalized. With all those in the population not on DMARDs as the reference category, the rate ratio for hospitalized COVID-19 associated with DMARD treatment was 2.14 [95% confidence interval (CI) 2.02–2.26] in those on conventional synthetic (cs) DMARDs, 2.01 (95% CI 1.38–2.91) in those on tumour necrosis factor (TNF) inhibitors as the only targeted agent, and 3.83 (95% CI 2.65–5.56) in those on other targeted DMARDs. Among those on csDMARDs, rate ratios for hospitalized COVID-19 were lowest at 1.66 (95% CI 1.51–1.82) in those on methotrexate and highest at 5.4 (95% CI 4.4–6.7) in those on glucocorticoids at an average dose > 10 mg/day prednisolone equivalent. Conclusion: The risk of hospitalized COVID-19 is elevated in IRD patients treated with immunosuppressive drugs compared with the general population. Of these drugs, methotrexate, hydroxychloroquine, and TNF inhibitors carry the lowest risk. The highest risk is associated with prednisolone. A larger study is needed to estimate reliably the risks associated with each class of targeted DMARD.

AB - Objective: To investigate the association of severe coronavirus disease 2019 (COVID-19) in patients with inflammatory rheumatic diseases (IRDs) treated with immunosuppressive drugs. Method: A list of 4633 patients on targeted–biological or targeted synthetic–DMARDs in March 2020 was linked to a case–control study that includes all cases of COVID-19 in Scotland. Results: By 22 November 2021, 433 of the 4633 patients treated with targeted DMARDS had been diagnosed with COVID-19, of whom 58 had been hospitalized. With all those in the population not on DMARDs as the reference category, the rate ratio for hospitalized COVID-19 associated with DMARD treatment was 2.14 [95% confidence interval (CI) 2.02–2.26] in those on conventional synthetic (cs) DMARDs, 2.01 (95% CI 1.38–2.91) in those on tumour necrosis factor (TNF) inhibitors as the only targeted agent, and 3.83 (95% CI 2.65–5.56) in those on other targeted DMARDs. Among those on csDMARDs, rate ratios for hospitalized COVID-19 were lowest at 1.66 (95% CI 1.51–1.82) in those on methotrexate and highest at 5.4 (95% CI 4.4–6.7) in those on glucocorticoids at an average dose > 10 mg/day prednisolone equivalent. Conclusion: The risk of hospitalized COVID-19 is elevated in IRD patients treated with immunosuppressive drugs compared with the general population. Of these drugs, methotrexate, hydroxychloroquine, and TNF inhibitors carry the lowest risk. The highest risk is associated with prednisolone. A larger study is needed to estimate reliably the risks associated with each class of targeted DMARD.

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SN - 0300-9742

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JF - Scandinavian Journal of Rheumatology

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ER -

Risk of severe COVID-19 in patients with inflammatory rheumatic diseases treated with immunosuppressive therapy in Scotland

Abstract

Bibliographical note

Data Availability Statement

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