Faculty Collaboration Database

Antirheumatic Disease Therapies for the Treatment of COVID-19: A Systematic Review and Meta-Analysis. Arthritis Rheumatol 2021 Jan;73(1):36-47

Date

08/03/2020

Pubmed ID

32741139

Pubmed Central ID

PMC7435536

DOI

10.1002/art.41469

Scopus ID

2-s2.0-85090870028 (requires institutional sign-in at Scopus site)   49 Citations

Abstract

OBJECTIVE: Antirheumatic disease therapies have been used to treat coronavirus disease 2019 (COVID-19) and its complications. We conducted a systematic review and meta-analysis to describe the current evidence.

METHODS: A search of published and preprint databases in all languages was performed. Included studies described ≥1 relevant clinical outcome for ≥5 patients who were infected with severe acute respiratory syndrome coronavirus 2 and were treated with antirheumatic disease therapy between January 1, 2019 and May 29, 2020. Pairs of reviewers screened articles, extracted data, and assessed risk of bias. A meta-analysis of effect sizes using random-effects models was performed when possible.

RESULTS: The search identified 3,935 articles, of which 45 were included (4 randomized controlled trials, 29 cohort studies, and 12 case series). All studies evaluated hospitalized patients, and 29 of the 45 studies had been published in a peer-reviewed journal. In a meta-analysis of 3 cohort studies with a low risk of bias, hydroxychloroquine use was not significantly associated with mortality (pooled hazard ratio [HR] 1.41 [95% confidence interval (95% CI) 0.83, 2.42]). In a meta-analysis of 2 cohort studies with some concerns/higher risk of bias, anakinra use was associated with lower mortality (pooled HR 0.25 [95% CI 0.12, 0.52]). Evidence was inconclusive with regard to other antirheumatic disease therapies, and the majority of other studies had a high risk of bias.

CONCLUSION: In this systematic review and meta-analysis, hydroxychloroquine use was not associated with benefit or harm regarding COVID-19 mortality. The evidence supporting the effect of other antirheumatic disease therapies in COVID-19 is currently inconclusive.

Author List

Putman M, Chock YPE, Tam H, Kim AHJ, Sattui SE, Berenbaum F, Danila MI, Korsten P, Sanchez-Alvarez C, Sparks JA, Coates LC, Palmerlee C, Peirce A, Jayatilleke A, Johnson SR, Kilian A, Liew J, Prokop LJ, Murad MH, Grainger R, Wallace ZS, Duarte-García A, COVID-19 Global Rheumatology Alliance

Author

Michael Putman MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Antirheumatic Agents
Azetidines
Bias
Chloroquine
Disease Progression
Glucocorticoids
Humans
Hydroxychloroquine
Immunoglobulins, Intravenous
Immunologic Factors
Interleukin 1 Receptor Antagonist Protein
Janus Kinase Inhibitors
Proportional Hazards Models
Purines
Pyrazoles
Sulfonamides