Objective To investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA). Methods We analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders. Results Of 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity. Conclusions People with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.

Objective The relative risk of SARS-CoV-2 infection and COVID-19 disease severity among people with rheumatic and musculoskeletal diseases (RMD) compared to those without RMD remains uncertain. We sought to quantify the risk for SARS-CoV-2 infection and describe clinical outcomes of COVID-19 in people with RMD. Methods A systematic literature review was conducted using 14 databases from January 1^st, 2019 to February 13^th, 2021. We included observational studies and experimental trials in RMD patients reporting comparative rates of SARS-CoV-2 infection, hospitalization, oxygen supplementation/ICU admission/mechanical ventilation, or mortality attributed to COVID-19. Methodological quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tools or the Newcastle-Ottawa scale. Risk ratios (RRs) and odds ratios (ORs) were calculated, as applicable for each outcome, using the Mantel-Haenszel formula with random effect models. Results Of 5799 abstracts screened, 100 studies met criteria for inclusion in the systematic review and 54/100 had a low risk-of-bias. Among studies included in the meta-analyses, we found an increased prevalence of SARS-CoV-2 infection in people with RMD (RR 1.53 (95%CI 1.16, 2.01)) compared with the general population. Odds of hospitalization, ICU admission, and mechanical ventilation were similar in patients with and without RMD, whereas odds of mortality was increased (OR 1.74 (95%CI 1.08, 2.80)). A smaller number of studies reported adjusted risk for outcomes and variably demonstrated increased risk for no difference in risk. Conclusion Patients with RMDs had higher rates of SARS-CoV-2 infection and increased odds of mortality.