Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry

Jeffrey A. Sparks, Zachary S. Wallace, Andrea M. Seet, Milena A. Gianfrancesco, Zara Izadi, Kimme L. Hyrich, Anja Strangfeld, Laure Gossec, Loreto Carmona, Elsa F. Mateus, Saskia Lawson-Tovey, Laura Trupin, Stephanie Rush, Patricia Katz, Gabriela Schmajuk, Lindsay Jacobsohn, Leanna Wise, Emily L. Gilbert, Ali Duarte-García, Maria O. Valenzuela-AlmadaGuillermo J. Pons-Estel, Carolina A. Isnardi, Guillermo A. Berbotto, Tiffany Y.T. Hsu, Kristin M. D'Silva, Naomi J. Patel, Lianne Kearsley-Fleet, Martin Schäfer, Sandra Lúcia Euzébio Ribeiro, Samar Al Emadi, Liselotte Tidblad, Carlo Alberto Scirè, Bernd Raffeiner, Thierry Thomas, René Marc Flipo, Jérôme Avouac, Raphaèle Seror, Miguel Bernardes, Maria Margarida Cunha, Rebecca Hasseli, Hendrik Schulze-Koops, Ulf Müller-Ladner, Christof Specker, Viviane Angelina De Souza, Licia Maria Henrique Da Mota, Ana Paula Monteiro Gomides, Philippe Dieudé, Elena Nikiphorou, Vanessa L. Kronzer, Namrata Singh, Manuel F. Ugarte-Gil, Beth Wallace, Akpabio Akpabio, Ranjeny Thomas, Suleman Bhana, Wendy Costello, Rebecca Grainger, Jonathan S. Hausmann, Jean W. Liew, Emily Sirotich, Paul Sufka, Philip C. Robinson, Pedro M Machado, Jinoos Yazdany

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Objective To investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA). Methods We analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders. Results Of 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity. Conclusions People with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.

Original languageEnglish
Pages (from-to)1137-1146
Number of pages10
JournalAnnals of the rheumatic diseases
Issue number9
Early online date12 Aug 2021
Publication statusPublished - 1 Sept 2021


  • Aged
  • Antirheumatic Agents/therapeutic use
  • Arthritis, Rheumatoid/complications
  • COVID-19/complications
  • Female
  • Humans
  • Male
  • Middle Aged
  • Registries
  • SARS-CoV-2
  • Severity of Illness Index


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