Effects of Biologic Therapies on the Chance of COVID-19 Infection Among Rheumatoid Arthritis and Lupus Patients During the First Wave of the Pandemic

risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite the effectiveness of usingcombined conventional and biological disease-modifying anti-rheumatic drugs(bDMARDs) in managing rheumaticdiseases, there have been concerns that taking biological agents may have an additive effect on getting infected withCOVID-19. This study evaluates the impact of taking biological agents on altering the chance of getting infected withSARS-CoV-2 in rheumatoloid and lupus patients compared to traditional DMARDs.

We carried out a cross-sectional survey study from February 2020 to January 2021 on patients diagnosedwith lupus and rheumatid arthritis. COVID-19 infection was confirmed by the presence of symptoms and signs of the diseaseand para-clinical findings such as lymphopenia and elevated C-reactive protein (CRP) and positive chest CT scanor polymerase chain reaction (PCR) of COVID-19.

Out of 591 patients included in this study, 422 (71.4%) had rheumatoid arthritis (RA), and 169 (28.6%) hadsystemic lupus erythematosus (SLE). Among them, 56 (9.5%) cases were diagnosed with COVID-19 infection. Noassociation was found between age, gender, or type of rheumatological diseases and SARS-CoV-2. There was asignificant association between COVID-19 infection and treatment with biological drugs (P-value<0.05) regardless ofthe type of rheumatologic disease. Interestingly, the analysis revealed that the type of biologic drug also altered thechance of COVID-19 infection; In fact, patients who took TNF inhibitors were significantly at a higher risk of diseasethan those taking Rituximab (P-value=0.000). Identical results were observed among RA patients (P-value<0.001),however, all 5 (3%) lupus cases treated with Rituximab infected with covid 19.

This study develops a better understanding of the risk of immunosuppressive medications for SARSCoV-2 infection. Patients treated with conventional and biological medicine had a higher disease risk than those takingexclusively conventional drugs. However, more studies are required to deliberate the relation of the reviewed factorswith the severity of COVID-19.Level of evidence: II