AB0695 PATTERN OF COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES UNDERGOING BIOLOGICAL THERAPY: A COHORT EXPERIENCE
Authors: C. Ancuta, C. Pomirleanu, G. Strugariu, L. Petrariu, E. Ancuta, C. Bran, R. Chirieac, C. Mihailov
Journal: Annals of the Rheumatic Diseases (2021)

Background: Despite emerging vaccines, the world is in the midst of a coronavirus disease 2019 (COVID-19) pandemic. Outcomes of SARS-CoV2 infection remain a major concern in patients with rheumatic and musculoskeletal diseases, especially for those with uncontrolled disease. Objectives: We aimed to investigate trends and outcomes of COVID-19 occurring in patients with chronic inflammatory rheumatic conditions treated with biologics and targeted synthetic disease modifying antirheumatic drugs (bDMARDs, tsDMARDs). Methods: We included all confirmed cases of COVID-19 regardless of severity in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) undergoing bDMARDs or tsDMARDs treatment registered in our local COVID-19 reporting database. We collected relevant information about comorbidities, rheumatologic-related clinical activity (RAPID5, SDAI, BASDAI, DAPSA), type of DMARD and glucocorticoid use, as well as COVID-19 related data as severity (ranging from asymptomatic to life-threatening forms), medication, hospitalization, intensive care unit admission, invasive mechanical ventilation and death. We did a subgroup analysis among patients with a specific rheumatologic diagnosis, among different class of medication, patients who were or not hospitalized with COVID-19 looking how age, comorbidities, type of rheumatic condition and treatments impact COVID outcomes. Results: 40 COVID-19 cases (positive PCR for SARS-CoV2) (4.67%) were identified during the 6-month study period among 855 patients registered in our database of patients under biologic treatment, including 20 RA, 18 SpA, 2 PsA patients. The majority were in either low disease activity or remission, only two patients had active uncontrolled disease at the onset of coronavirus infection. 16 cases (40%) were asymptomatic and were tested RT-PCR-positive during routine follow-ups for their disease, 13 cases (32.5%) had mild and 8 cases (20%) moderate illness; severe pneumonia and critical disease with acute respiratory distress syndrome were reported in only 3 cases, 2 recovered after; the only patients who died was 69 years old, had cardiac disease, hypertension and diabetes, had undertaken regular rituximab perfusion one month before coronavirus infection and developed pulmonary embolism followed by septic shock. Extreme fatigue was the dominant COVID-19 associated symptom apart from the classical ones including fever, cough, shortness of breath, sore throat, nasal congestion, headache, anosmia and ageusia myalgias and anorexia. No specific pattern for patients requiring intensive care unit admission. Conclusion: The COVID-16 infection rate in patients with inflammatory rheumatic disorders receiving biologics and tsDMARDs is pretty low; although immunosuppressed, these patients seem not to be at risk for severe COVID-19 illness and outcomes. These findings might reflect a potential protective role of certain biologics and/or JAK inhibitors for development and severity of COVID-19 in patients. References: [1]WHO, COVID-19 clinical management, Living Guidance, 25 Jan 2021 Disclosure of Interests: CODRINA ANCUTA Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Consultant of: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Cristina Pomirleanu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Georgiana Strugariu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Luiza Petrariu Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Eugen Ancuta: None declared, Codruta Bran Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Rodica Chirieac Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Claudia Mihailov Speakers bureau: Abbvie, Pfizer, Lilly, Novartis, Sandoz, Consultant of: Abbvie, Pfizer, Lilly, Novartis, Sandoz