COVID-19 presentation and outcomes in patients with inflammatory rheumatic and musculoskeletal diseases receiving IL6-receptor antagonists prior to SARS-CoV-2 infection

IF 4.7 Q2 IMMUNOLOGY Journal of Translational Autoimmunity Pub Date : 2023-01-01 DOI:10.1016/j.jtauto.2023.100190
Cloé Comarmond , Elodie Drumez , Julien Labreuche , Eric Hachulla , Thierry Thomas , René-Marc Flipo , Raphaëlle Seror , Jérôme Avouac , Nathalie Balandraud , Renaud Desbarbieux , Renaud Felten , Mélanie Gilson , Marie-Hélène Guyot , Ambre Hittinger-Roux , Thao Pham , Myriam Renard , Nicolas Roux , Vincent Sobanski , Anne Tournadre , Christophe Richez , Patrice Cacoub
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Abstract

Objective

COVID-19 outcome may be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases (RMD) receiving immunosuppressive therapy. We aimed to investigate whether RMD patients on anti-IL6 therapy prior to SARS-CoV-2 infection have less severe disease and better outcomes of COVID-19.

Methods

We conducted a retrospective national, multicentre cohort study using data from the French RMD COVID-19 cohort. We compared the severity and outcome of highly suspected or confirmed COVID-19 infection in RMD patients previously treated with tocilizumab or sarilumab (anti-IL6 group) with patients who did not receive anti-IL6 therapy (no anti-IL6 group).

Results

Data were collected for 1883 patients with mean age of 55.2 years [SD 16.7] and 1256 (66.7%) female. Two hundred ten (11.1%) developed severe COVID-19 and 115 (6.4%) died. After adjusting for potential confounding factors, severe COVID-19 was less frequent in the anti-IL6 group compared with the no anti-IL6 group (aOR for moderate vs. mild severity, 0.23 [95% CI, 0.10 to 0.54], p ≤ 0.01 and aOR for severe vs. mild, 0.29 [95% CI, 0.10 to 0.81], p ≤ 0.01). No significant differences were found for the evolution of COVID-19 between the anti-IL6 group and the no anti-IL6 group (aOR for recovery with sequelae vs recovery without sequelae, 0.78 [95% CI, 0.41 to 1.48] and aOR for death vs recovery without sequelae, 0.29 [95% CI, 0.07 to 1.30]).

Conclusion

RMD patients receiving anti-IL6 therapy prior to SARS-CoV-2 infection have less severe forms of COVID-19. No difference was observed in COVID-19 evolution, i.e., sequelae or death, between the groups.

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在感染SARS-CoV-2之前接受il - 6受体拮抗剂治疗的炎症性风湿病和肌肉骨骼疾病患者的COVID-19表现和结局
目的在接受免疫抑制治疗的炎性风湿性和肌肉骨骼疾病(RMD)患者中,新冠肺炎的预后可能不太好。我们旨在调查在感染SARS-CoV-2之前接受抗IL6治疗的RMD患者是否具有较轻的疾病和更好的COVID-19结局。方法我们使用法国RMD COVID-19]队列的数据进行了一项回顾性的全国多中心队列研究。我们比较了先前接受过tocilizumab或sarilumab治疗的RMD患者(抗IL6组)与未接受抗IL6治疗的患者(无抗IL6小组)中高度怀疑或确诊的新冠肺炎感染的严重程度和结果。210人(11.1%)出现严重新冠肺炎,115人(6.4%)死亡。在对潜在的混杂因素进行调整之后,与无抗IL6组相比,抗IL6治疗组严重新冠肺炎的发生率较低(中度与轻度的aOR为0.23[95%CI,0.10-0.54],p≤0.01,重度与轻度的oOR为0.29[95%CI:0.10-0.81],p≤0.01])(有后遗症的恢复与无后遗症的恢复的aOR为0.78[95%CI,0.41-1.48],死亡与无后遗症恢复的aOR0.29[95%CI:0.07-13.0])。结论在感染SARS-CoV-2之前接受抗IL6治疗的RMD患者患有较轻形式的新冠肺炎。新冠肺炎的演变,即后遗症或死亡,两组之间没有观察到差异。
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来源期刊
Journal of Translational Autoimmunity
Journal of Translational Autoimmunity Medicine-Immunology and Allergy
CiteScore
7.80
自引率
2.60%
发文量
33
审稿时长
55 days
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