Clinical Outcomes of CoVid-19 in Patients Taking Tumor Necrosis Factor Inhibitors and/or Methotrexate: A Multi-Center Research Network Study

J Am Acad Dermatol. 2020 Sep 11;S0190-9622(20)32593-7. doi: 10.1016/j.jaad.2020.09.009. Online ahead of print.

Abstract

Background: Data on the impact of biologics and immunomodulators on CoVid-19 related outcomes remains scarce.

Objective: To determine whether patients on tumor necrosis factor inhibitor (TNFi) and/or methotrexate are at increased risk of CoVid-19 related outcomes.

Methods: In this large comparative cohort study, a real-time search and analysis were performed on adult patients diagnosed with CoVid-19 and treated with TNFi and/or methotrexate versus those not treated. Likelihood of hospitalization and mortality were compared between groups with and without propensity score matching for confounding factors.

Results: 53,511,836 unique patient records were analyzed, of which 32,076 (0.06%) had a CoVid-19-related diagnosis documented starting after January 20, 2020. 214 patients with CoVid-19 were identified with recent TNFi or methotrexate exposure compared to 31,862 patients with CoVid-19 without TNFi or methotrexate exposure. After propensity matching, likelihood of hospitalization and mortality were not significantly different between the treatment and non-treatment group (risk ratio 0.91, 95% confidence interval [CI] 0.68-1.22, p=0.5260; risk ratio 0.87, 95% CI 0.42-1.78, p=0.6958, respectively).

Limitations: All TNFi may not behave similarly.

Conclusion: Our study suggests that patients with recent TNFi and/or methotrexate exposure do not have increased hospitalization or mortality compared to CoVid-19 patients without recent TNFi and/or methotrexate exposure.

Keywords: CoVid-19; TNF-alpha; coronavirus; methotrexate; tumor necrosis factor alpha inhibitor.