AUTHOR=Hasseli Rebecca , Hanses Frank , Stecher Melanie , Specker Christof , Weise Tobias , Borgmann Stefan , Hasselberger Martina , Hertenstein Bernd , Hower Martin , Hoyer Bimba F. , Koll Carolin , Krause Andreas , von Lilienfeld-Toal Marie , Lorenz Hanns-Martin , Merle Uta , Nunes de Miranda Susana M. , Pletz Mathias W. , Regierer Anne C. , Richter Jutta G. , Rieg Siegbert , Roemmele Christoph , Ruethrich Maria M. , Schmeiser Tim , Schulze-Koops Hendrik , Strangfeld Anja , Vehreschild Maria J.G.T. , Voit Florian , Voll Reinhard E. , Vehreschild Jörg Janne , Müller-Ladner Ulf , Pfeil Alexander 

TITLE=The protective effect of tumor necrosis factor-alpha inhibitors in COVID-19 in patients with inflammatory rheumatic diseases compared to the general population—A comparison of two German registries

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1332716

DOI=10.3389/fmed.2024.1332716

ISSN=2296-858X

ABSTRACT=Objectives: To investigate, whether inflammatory rheumatic diseases (IRD) inpatients are at higher risk to develop a severe course of SARS-CoV-2 infections compared to the general population, data from the German COVID-19 registry for IRD patients and data from the Lean European Survey on SARS-CoV-2 (LEOSS) covering inpatients from the general population with SARS-CoV-2 infections were compared.

Methods: 4310 (LEOSS registry) and 1139 cases (IRD registry) were collected in general. Data were matched for age and gender. From both registries, 732 matched inpatients (LEOSS registry: n=366 and IRD registry: n=366) were included for analyses in total. 

Results: Regarding the COVID-19 associated lethality, no significant difference between both registries was observed. Age > 65 years, chronic obstructive pulmonary disease, diabetes mellitus, rheumatoid arthritis, spondyloarthritis and the use of rituximab were associated with more severe courses of COVID-19. Female gender and the use of tumor necrosis factor-alpha inhibitors (TNF-I) were associated with a better outcome of COVID-19.

Conclusion: IRD patients have the same risk factors for severe COVID-19 regarding comorbidities compared to the general population without any immune-mediated disease or immunomodulation. The use of rituximab was associated with an increased risk for severe COVID-19. On the other hand, the use of TNF-I was associated with less severe COVID-19 compared to the general population, which might indicate a protective effect of TNF-I against severe COVID-19 disease.