TNF-α Blockers Showed Prophylactic Effects in Preventing COVID-19 in Patients with Rheumatoid Arthritis and Seronegative Spondyloarthropathies: A Case-Control Study

Mansour Salesi; Behrokh Shojaie; Ziba Farajzadegan; Naghmeh Salesi; Erfan Mohammadi

doi:10.1007/s40744-021-00342-8

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 Sep;8(3):1355-1370. doi: 10.1007/s40744-021-00342-8. Epub 2021 Jul 23.

Authors

Mansour Salesi^{1

2}, Behrokh Shojaie^{3

4}, Ziba Farajzadegan⁵, Naghmeh Salesi⁶, Erfan Mohammadi⁶

Affiliations

¹ Division of Rheumatology, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. salesi@med.mui.ac.ir.
² Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. salesi@med.mui.ac.ir.
³ Division of Rheumatology, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
⁵ Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
⁶ Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

Abstract

Introduction: The interaction between angiotensin-converting enzyme 2 (ACE2) and SARS-CoV-2 is a crucial factor in the viral infections leading to the release of inflammatory proteins, such as TNF-α. Thus, it is hypothesized that TNF-α blockers can prevent either COVID-19 incidence or its serious symptoms. TNF-α blockers are prescribed to treat various autoimmune disorders, including rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA). Therefore, the objective of this work was to examine this hypothesis that TNF-α blockers can prevent COVID-19 incidence in patients with RA or SpA.

Methods: A case-control study was conducted through interviews based on a structured questionnaire to investigate the frequency of COVID-19 incidence in 254 eligible patients with RA or SpA about whom 45% were under treatment with one type of TNF-α blockers including infliximab, adalimumab, and etanercept at least for 3 months during the COVID-19 pandemic. Interviews were carried out twice, at the beginning and the end of the study (June-December 2020). Patients with COVID-19 during the study or before that were considered as cases. The control group was patients without COVID-19 experience. Data were analyzed using descriptive statistics, and logistic regression was used to determine the relationships between COVID-19 incidence and independent variables.

Results: A small percentage of patients treated with TNF-α blockers (5.22%, 6/115) experienced COVID-19, while a large percentage of patients with COVID-19 did not receive TNF-α blockers (27.34%, 38/139). According to odds ratio, adalimumab, infliximab, and etanercept decreased significantly the risk of developing COVID-19 up to 96.8, 95, and 80.3% (p < 0.05), respectively. Therefore, TNF-α blockers could probably decrease the chances of the COVID-19 incidence in patients with RA or SpA.

Conclusions: A direct and positive correlation between the use of TNF-α blockers and a reduction in the incidence of COVID-19 could suggest the prophylactic role of these drugs in preventing COVID-19 in patients with RA and SpA.

Keywords: COVID-19; Rheumatoid arthritis; Seronegative spondyloarthropathies; TNF-α blockers.

Grants and funding

199119/Isfahan University of Medical Sciences