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

Document Type : RESEARCH PAPER


1 Rheumatic Diseases Research Center (RDRC), Mashhad Universality of Medical Sciences, Mashhad, Iran

2 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite the effectiveness of using
combined conventional and biological disease-modifying anti-rheumatic drugs(bDMARDs) in managing rheumatic
diseases, there have been concerns that taking biological agents may have an additive effect on getting infected with
COVID-19. This study evaluates the impact of taking biological agents on altering the chance of getting infected with
SARS-CoV-2 in rheumatoloid and lupus patients compared to traditional DMARDs.
Methods: We carried out a cross-sectional survey study from February 2020 to January 2021 on patients diagnosed
with lupus and rheumatid arthritis. COVID-19 infection was confirmed by the presence of symptoms and signs of the disease
and para-clinical findings such as lymphopenia and elevated C-reactive protein (CRP) and positive chest CT scan
or polymerase chain reaction (PCR) of COVID-19.
Results: Out of 591 patients included in this study, 422 (71.4%) had rheumatoid arthritis (RA), and 169 (28.6%) had
systemic lupus erythematosus (SLE). Among them, 56 (9.5%) cases were diagnosed with COVID-19 infection. No
association was found between age, gender, or type of rheumatological diseases and SARS-CoV-2. There was a
significant association between COVID-19 infection and treatment with biological drugs (P-value<0.05) regardless of
the type of rheumatologic disease. Interestingly, the analysis revealed that the type of biologic drug also altered the
chance of COVID-19 infection; In fact, patients who took TNF inhibitors were significantly at a higher risk of disease
than 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.
Conclusion: 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 taking
exclusively conventional drugs. However, more studies are required to deliberate the relation of the reviewed factors
with the severity of COVID-19.
Level of evidence: II


Volume 10, Issue 11
November 2022
Pages 946-968
  • Receive Date: 31 August 2021
  • Revise Date: 05 April 2022
  • Accept Date: 07 April 2022
  • First Publish Date: 17 October 2022