Patients receiving immune-modulating antirheumatic drugs are not at increased risk or have greater disease severity of infection with the coronavirus disease 2019 (COVID-19), according to a letter published in Annals of the Rheumatic Diseases.

It is unclear whether treatment with immunomodulatory agents alters the susceptibility or severity of COVID-19 infection. In a population-based study in the Reggio Emilia region of Italy, investigators aimed to evaluate the effect of treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) on risk for COVID-19 infection and severity.

A total of 1195 individuals (56.2% women) from among over 500,000 residents in the Reggio Emilia region were treated with bDMARDs or tsDMARDs. Compared with all residents, those treated with DMARDs were tested for COVID-19 at a significantly higher frequency (1.4% vs 1.7%; P =.001), but there was no significant difference in the frequency of positive swabs (47.1% vs 36.0%; P =.318). There was no significant difference in the rate of hospitalization between individuals treated with DMARDs compared with all residents (44.4% vs 35.8%; P =.730). The frequency of death was also similar between groups (10.2% vs 11.1%; P =1.000). After adjusting for age and sex, patients treated with bDMARDs or tsDMARDs had a tendency to be more likely to be tested (odds ratio [OR], 1.19; 95% CI, 0.80-1.77), frequently tested positive (OR, 0.62; 95% CI, 0.27-1.42), and hospitalized (hazard ratio, 1.28; 95% CI, 0.32-5.11); however, these associations were not significant.

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Researchers noted that the small sample size represented a limitation of the study and that further prospective studies with larger patient samples were needed to confirm results of this study.

“[W]e did not find any statistically significant difference regarding the probability of being tested, having a positive swab when tested, being [hospitalized] and dying in our patients treated with bDMARDs or tsDMARDs,” the study authors concluded. “[O]ur study did not show a different susceptibility and severity of COVID-19 in patients treated with bDMARDs or tsDMARDs.”


Salvarani C, Bajocchi G, Mancuso P, et al. Susceptibility and severity of COVID-19 in patients treated with bDMARDS and tsDMARDs: a population-based study. Letter. Ann Rheum Dis. 2020;79:986-988.

This article originally appeared on Rheumatology Advisor