THE COURSE of COVID-19 INFECTION in PATIENTS with RHEUMATOID ARTHRITIS RECEIVING VARIOUS BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

ABSTRACT

Background: With the ongoing COVID-19 pandemic, the safety of biologic disease-modifying antirheumatic drugs in patients with rheumatic disease remains an important issue. Objectives: to assess the course of COVID-19 infection in patients with rheumatoid arthritis receiving various biological disease-modifying antirheumatic drugs. Methods: An analysis was made of the course of COVID-19 in patients with rheumatic diseases who were under observation at the North-Western State Medical University. I.I. Mechnikov in the period from March 2020 to November 2021. During this period, 198 (14.04%) cases of COVID-19 were registered out of 1389 patients included in the registries of the anticytokine therapy center. Among patients with rheumatoid arthritis who recovered from COVID-19 infection, 105 cases were registered, of which 53 patients received outpatient treatment, and 52 patients received inpatient treatment. In 76% of cases, patients received biological DMARDs in combination with synthetic DMARDs. Results: Exacerbation of the articular syndrome was observed only in 12 (11.4%) patients with RA during COVID-19. The low percentage of exacerbations in patients with RD on the background of COVID-19 was probably associated with the use of dexamethasone at a dose of 16-32 mg, which has the ability to reduce the activity of the immune-infammatory process in rheumatic diseases. This statement is confrmed by the fact that out of 52 patients with RA who were hospitalized for COVID-19, 16 patients (30.8%) received dexamethasone intramuscularly or intravenously, and 8 patients (15.4%) continued oral administration of this drug. Conclusion: The use of rituximab was associated with a more severe course of COVID-19, which required hospitalization in 66% of cases, compared with the group of patients treated with TNF-α inhibitors, in which hospital treatment was carried out only in 20% of cases. The introduction of blockers of co-stimulation of T-cells, IL-6 inhibitors, targeted synthetic drugs did not affect the severity of COVID-19.