TNF Inhibition Associated With Lower Risk of Adverse COVID-19 Outcomes

An international research group has found that patients with immune-mediated inflammatory diseases (IMIDs) who were treated with tumor necrosis factor (TNF) inhibitor monotherapy during the pandemic had lower risk of adverse COVID-19 outcomes than other therapies. The results of their study were published in JAMA Network Open.

To examine the association between COVID-19 hospitalization and commonly prescribed immunomodulatory therapies, the researchers performed a pooled analysis of three international COVID-19 registries for IMIDs. Included in the analysis were adults with psoriasis, inflammatory arthritis, or inflammatory bowel disease from March 12, 2020, to February 1, 2021. Within each digital registry, clinicians reported patient outcomes and characteristics. Treatments included were:

• TNF inhibitor monotherapy
• TNF inhibitors in combination with methotrexate (TNF-M)
• TNF inhibitors in combination with azathioprine/6-mercaptopurine therapy (TNF-AM)
• Methotrexate monotherapy (MM)
• Azathioprine/6-mercaptopurine monotherapy (AM)
• Janus kinase inhibitor monotherapy (JAK)

In total, 6077 patients were included, with 3563 (58.6%) women and a mean age (SD) of 48.8 (16.5) years. Of the total number of patients, 1297 (21.3%) were hospitalized and 189 (3.1%) died. Pooled analysis revealed that patients receiving TNF inhibitor monotherapy had the lowest odds of hospitalization or death compared with patients receiving any other therapy (TNF-AM, P=.006; AM, P=.001; MM, P<.001; JAK, P=.004), except patients who received TNF-M (P=.33).

The authors concluded that TNF inhibitor monotherapy was associated with a lower risk of adverse COVID-19 outcomes vs commonly prescribed immunomodulatory therapies for IMIDs.

Reference
Izadi Z, Brenner EJ, Mahil SK, et al. Association between tumor necrosis factor inhibitors and the risk of hospitalization or death among patients with immune-mediated inflammatory disease and COVID-19. JAMA Netw Open. 2021;4(10):e2129639. doi:10.1001/jamanetworkopen.2021.29639