Incidence of COVID‐19 in patients with rheumatic diseases treated with targeted immunosuppressive drugs: what can we learn from observational data?

Favalli, Ennio Giulio; Monti, Sara; Ingegnoli, Francesca; Balduzzi, Silvia; Caporali, Roberto; Montecucco, Carlomaurizio

OBJECTIVES: To describe the incidence and severity of coronavirus disease 2019 (COVID‐19) in rheumatic patients treated with targeted synthetic or biological anti‐rheumatic drugs (ts/bDMARDs) compared with the general population living in the same Italian region. METHODS: Patients followed at two referral rheumatology centres in Lombardy from 25(th) February to 10(th) April 2020 were invited to participate in a survey to detect patients with confirmed COVID‐19, close contacts with known COVID‐19 cases, symptoms of infection, working, behavioural and disease management changes applied to prevent the contagion. The incidence of COVID‐19 in the Lombardy population was obtained from the National Institute of Statistics. Confirmed COVID‐19 was defined by nasopharyngeal swab. RESULTS: The survey was circulated amongst 955 patients (531 rheumatoid arthritis, 203 psoriatic arthritis, 181 spondyloarthritis, and 40 of connective tissue diseases/vasculitides/autoinflammatory diseases; mean age 53.7 years; female: 67.4%). The rate of responders was 98.05%. The incidence of confirmed COVID‐19 is consistent with the general population (0.62% vs 0.66%; p=0.92). None of the patients had severe complications or required intensive care treatment, and all of them temporarily discontinued ongoing ts/bDMARDs therapy. Almost all patients adopted precautions to prevent the contagion (90.6%) and maintained the ongoing treatment with ts/bDMARDs (93.2%). The disease activity remained stable in 89.5% of patients. CONCLUSIONS: Our results highlight the attitude from rheumatic patients to prevent the contagion while maintaining their chronic treatments. The incidence and severity of COVID‐19 in patients treated with ts/bDMARDs was not significantly different from that of the general population in the same region.