EFFECTS of SULFASALAZINE USED in AXIAL SPONDYLOARTHRITIS on COVID-19 OUTCOMES: REAL-LIFE DATA from A SINGLE CENTER

ABSTRACT

Background: Compared to biologic-agents, little is known about effects of sul-fasalazine used for axial spondyloarthritis(AxSpA) on COVID-19 outcomes. Objectives: So, we aimed to understand the impact of sulfasalazine on COVID-19 in AxSpA patients. Methods: This was a retrospective study from a single center which included 2344 AxSpA patients. We analyzed 219 of 406 confrmed COVID-19 patients from March 2020 to July 2021. The primary outcome was COVID-19 severity in terms of COVID-19 pneumonia, hospitalization rate and length of hospitalization. Analyses were stratifed according to use of sulfasalazine and/or biologic-agents. Results: Most of the patients were male(59%) with a mean age of 45.0 years. Peripheral arthritis was present in 35% and uveitis in 15%. In total, sulfasalazine was used in 42% and biologic-agent in 42%. COVID-19 pneumonia detected in 16%, hospitalization required in 14% and median(IQR) duration of hospitalization was 10(8) days. Two patients died due to COVID-19. The sulfasalazine users had higher age, more frequent COVID-19 pneumonia, hospitalization and longer hospitalization. After biologic-agent users were excluded, the sulfasalazine group had again longer hospitalization. When patients regrouped as sulfasalazine mon-otherapy, sulfasalazine+biologic and biologic monotherapy, in pairwise comparisons, sulfasalazine monotherapy group had a higher frequency of COVID-19 pneumonia than biologic monotherapy group(p=0.008). Conclusion: Although sulfasalazine seemed to be related with increased rates of COVID-19 pneumonia and hospitalization, this impact diminished after exclusion of biologic-agent users. Sulfasalazine monotherapy and sulfasalazine+bio-logic therapy might be associated with development of COVID-19 pneumonia, compared to biologic monotherapy. Our results imply sulfasalazine may be related with worse disease course AxSpA patients with COVID-19.