Investigation of Clinical Characteristics of COVID-19 Infection in Rheumatoid Patients on Immunosuppressive Drugs: A Cross-sectional Study

Backgrounds : Cytokine storm has been considered as the main pathogenesis in COVID-19 patients with severe disease. Inflammatory cytokines, such as interleukin-6(IL-6), IL-1, and tumor necrosis factor alpha (TNF-α) released from the lung epithelium in COVID-19 infection are very similar to cytokines which are released in inflammatory rheumatic diseases. Immunosuppressive drugs are the cornerstone of treatment in many rheumatologic diseases. Prolonged use of these agents might result in change in the clinical characteristics of these individuals with COVID-19. Objective : To determine the clinical findings and disease severity of COVID-19 infection in patients with rheumatologic diseases who were on immunosuppressive therapy. Method : We retrospectively investigated 1000 subjects who were more than 18years old with rheumatologic diseases on immunosuppressive therapy in the recent three months. Demographic data, rheumatic disease characteristics, medications, and presence of any co- morbid conditions were documented by detail. Presence of severe COVID-19 infection features were compared between users and non-users of different immunosuppressant agents. Multivariable logistic regression was applied, and adjusted odd ratio (OR) and its 95% CI were estimated. Results : 539 subjects had positive history of COVID-19 (COVID-19+). Pre-exposure to prednisolone was associated with severe disease (OR: 2.52, 95%CI (1.192-4.255)). Pervious use of MTX (OR: 0.348, 95%CI (0.210-0.575)) and biologic drugs (OR: 0.332, 95%CI (0.159-0.694)) had protective effect on the severity of the disease. Other traditional disease modifying anti-rheumatic drugs (DMARD) had no clinical effect on the outcome of COVID-19 infection. Conclusion : In the current study, among rheumatoid patients on immunosuppressants, previous treatment with corticosteroids was associated with increased incidence, poor prognosis, and increased mortality. Pre-exposure to MTX or biologic agents such as anti-TNF and anti-CD20 had protective effect against coronavirus. Further meta-analysis and systematic review in large population is needed to accurately determine the effect and mechanism of these drugs on this new viral illness.