Effects of Biologic Therapies on the Chance of COVID-۱۹ Infection Among Rheumatoid Arthritis and Lupus Patients During the First Wave of the Pandemic

risk of severe acute respiratory syndrome coronavirus ۲ (SARS-CoV-۲) infection. Despite the effectiveness of usingcombined conventional and biological disease-modifying anti-rheumatic drugs(bDMARDs) in managing rheumaticdiseases, there have been concerns that taking biological agents may have an additive effect on getting infected withCOVID-۱۹. This study evaluates the impact of taking biological agents on altering the chance of getting infected withSARS-CoV-۲ in rheumatoloid and lupus patients compared to traditional DMARDs.Methods: We carried out a cross-sectional survey study from February ۲۰۲۰ to January ۲۰۲۱ on patients diagnosedwith lupus and rheumatid arthritis. COVID-۱۹ infection was confirmed by the presence of symptoms and signs of the diseaseand para-clinical findings such as lymphopenia and elevated C-reactive protein (CRP) and positive chest CT scanor polymerase chain reaction (PCR) of COVID-۱۹.Results: Out of ۵۹۱ patients included in this study, ۴۲۲ (۷۱.۴%) had rheumatoid arthritis (RA), and ۱۶۹ (۲۸.۶%) hadsystemic lupus erythematosus (SLE). Among them, ۵۶ (۹.۵%) cases were diagnosed with COVID-۱۹ infection. Noassociation was found between age, gender, or type of rheumatological diseases and SARS-CoV-۲. There was asignificant association between COVID-۱۹ infection and treatment with biological drugs (P-value<۰.۰۵) regardless ofthe type of rheumatologic disease. Interestingly, the analysis revealed that the type of biologic drug also altered thechance of COVID-۱۹ infection; In fact, patients who took TNF inhibitors were significantly at a higher risk of diseasethan those taking Rituximab (P-value=۰.۰۰۰). Identical results were observed among RA patients (P-value<۰.۰۰۱),however, all ۵ (۳%) lupus cases treated with Rituximab infected with covid ۱۹.Conclusion: This study develops a better understanding of the risk of immunosuppressive medications for SARSCoV-۲ infection. Patients treated with conventional and biological medicine had a higher disease risk than those takingexclusively conventional drugs. However, more studies are required to deliberate the relation of the reviewed factorswith the severity of COVID-۱۹.Level of evidence: II

Keywords:

Anti-TNFs , biological DMARDs , COVID-۱۹ , Adalimumab , Infliximab , Rituximab , Rheumatoid Arthritis (RA) , Systemic Lupus Erythematous (SLE) , Altebrel , CinnoRA