POSTER: SARS-COV 2 INFECTION and ANTI TNF THERAPY in RHEUMATOID ARTHRITIS PATIENTS

ABSTRACT

Background: High levels of tumor necrosis factor (TNF), a key proinfamma-tory cytokine, is associated with SARS-CoV-2 infection. In rheumatoid arthritis patients with SARS-CoV-2 infection, anti TNF therapy reduces not only TNF but other cytokines responsible for high morbidity and mortality. The severe systemic infammation in COVID-19 causes respiratory symptoms, fever, fatigue, neurological and gastrointestinal manifestations. Objectives: We followed the evolution of SARS-CoV-2 infection in rheumatoid arthritis patients who received anti TNF blockers. Methods: Our study included 95 rheumatoid arthritis patients who were diagnosed with SARS CoV-2 infection through a positive RT-PCR-SARS-CoV2 test. 21 patients were men and 74 were women. Mean age was 58 ±11,5. 24 patients received monotheraphy with anti TNF blockers (Adalimumab/Infiximab), 48 received TNF blockers in combination with Methotrexate (10 mg per week) and 23 received TNF blockers in combination with Lefunomide (20 mg per day). We followed serum ferritin, C reactive protein and D-dimer in all patients. 59 patients were vaccinated with two doses of Pfzer-BioNtech (64.1 %). The study group was analyzed from 30th December 2021 to 1st of January 2022. From 95 patients, 35 (36,8%) were hospitalized and 60 received ambulatory care. Results: Our patients with COVID-19 presented with asimptomatic forms, forms with mild symptoms and complicated forms that required hospitaliza-tion. No patients had died. Milder forms were associated with the use of TNF blockers and Methotrexate and patients with monotherapy-TNF blockers. They presented with mild symptoms (fever, arthralgia, odynophagia, dysgeu-sia/ageusia, anosmia). Hospitalization rate in patients who received mono-theraphy with TNF blockers was 29,1%, 31,2% in patients who received TNF blockers and Methotrexate and 56,5% in patients with TNF blockers and Lefunomide (69,3%). Factors associated with higher odds of hospitalization included older age (p=0,001), active disease (p=0,02), obesity (p=0,005), pulmonary chronic disease (p=0,02), diabetes (p=0,001) and concomitent dose of Lefunomide (p=0,0006). Female sex was associated with milder forms of the disease. Patients with high levels of D-dimer had a higher odd of hospital-ization (p<0,001). Strong positive correlation was observed between elevated D-dimers and hospitalization odds. Conclusion: TNF blockers in monotheraphy or associated with Methotrexate were correlated with lower odds of hospitalization and milder forms of COVID-19. No signifcant difference of hospitalization odd was observed between vaccinated and unvaccinated patients.