Background: High levels of tumor necrosis factor (TNF), a key proinflammatory cytokine, is associated with SARS-CoV-2 infection. In rheumatoid arthritis patients with SARS-CoV-2 infection, anti TNF therapy reduces not only TNF but other cytokines responsible for high morbidity and mortality.

The severe systemic inflammation in COVID-19 causes respiratory symptoms, fever, fatigue, neurological and gastrointestinal manifestations.

Objectives: We followed the evolution of SARS-CoV-2 infection in rheumatoid arthritis patients who received anti TNF blockers.

Methods: Our study included 95 rheumatoid arthritis patients who were diagnosed with SARS CoV-2 infection through a positive RT-PCR-SARS-CoV2 test. 21 patients were men and 74 were women. Mean age was 58 ±11,5. 24 patients received monotheraphy with anti TNF blockers (Adalimumab/ Infliximab), 48 received TNF blockers in combination with Methotrexate (10 mg per week) and 23 received TNF blockers in combination with Leflunomide (20 mg per day).

We followed serum ferritin, C reactive protein and D-dimer in all patients. 59 patients were vaccinated with two doses of Pfizer-BioNtech (64.1 %).

The study group was analyzed from 30th December 2021 to 1st of January 2022. From 95 patients, 35 (36,8%) were hospitalized and 60 received ambulatory care.

Results: Our patients with COVID-19 presented with asimptomatic forms, forms with mild symptoms and complicated forms that required hospitalization. No patients had died.

Milder forms were associated with the use of TNF blockers and Methotrexate and patients with monotherapy – TNF blockers. They presented with mild symptoms (fever, arthralgia, odynophagia, dysgeusia/ageusia, anosmia). Hospitalization rate in patients who received monotheraphy with TNF blockers was 29,1%, 31,2% in patients who received TNF blockers and Methotrexate and 56,5% in patients with TNF blockers and Leflunomide (69,3%). Factors associated with higher odds of hospitalization included older age (p=0,001), active disease (p=0,02), obesity (p=0,005), pulmonary chronic disease (p=0,02), diabetes (p=0,001) and concomitent dose of Leflunomide (p=0,0006).

Female sex was associated with milder forms of the disease. Patients with high levels of D-dimer had a higher odd of hospitalization (p<0,001). Strong positive correlation was observed between elevated D-dimers and hospitalization odds.

Conclusion: TNF blockers in monotheraphy or associated with Methotrexate were correlated with lower odds of hospitalization and milder forms of COVID-19. No significant difference of hospitalization odd was observed between vaccinated and unvaccinated patients.

REFERENCES:

[1]Brito CA, Paiva JG, Pimentel FN , et al. COVID-19 in patients with rheumatological diseases treated with anti-TNF. Annals of the Rheumatic Diseases 2021; 80: e62.

[2]Alesi M, Shojaie B, Farajzadegan Z, Salesi N, Mohammadi E. TNF-α Blockers Showed Prophylactic Effects in Preventing COVID-19 in Patients with Rheumatoid Arthritis and Seronegative Spondyloarthropathies: A Case-Control Study. Rheumatol Ther. 2021 Jul 23:1-16. doi: 10.1007/s40744-021-00342-8. Epub ahead of print. PMID: 34316436.

[3]Baslilar S, Pehlivan O. Evaluation of factors affecting the frequency and clinical course of COVID-19 in patients using anti-TNF-alpha agents. Rev Assoc Med Bras (1992). 2021 Sep;67(9):1286-1292. doi: 10.1590/1806-9282.20210568. PMID: 34816922.

Disclosure of Interests: None declared