Rituximab is associated with worse COVID-19 outcomes in patients with rheumatoid arthritis: A retrospective, nationally sampled cohort study from the U.S. National COVID Cohort Collaborative (N3C)

Semin Arthritis Rheum. 2023 Feb:58:152149. doi: 10.1016/j.semarthrit.2022.152149. Epub 2022 Dec 8.

Abstract

Objective: To assess whether rituximab (RTX) is associated with worse COVID-19 outcomes among patients with rheumatoid arthritis (RA).

Methods: We used the National COVID Cohort Collaborative (N3C), the largest US cohort of COVID-19 cases and controls, to identify patients with RA (International Classification of Diseases (ICD)-10 code, M05.X or M06.X). Key outcomes were COVID-19-related hospitalization, intensive care unit (ICU) admission, 30-day mortality, and World Health Organization (WHO) classification for COVID-19 severity. We used multivariable logistic regression models to assess the association between RTX use and the odds of COVID-19 outcomes compared with the use of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), adjusting for demographics, medical comorbidities, smoking status, body mass index, US region and COVID-19 treatments.

Results: A total of 69,549 patients met our eligibility criteria of which 22,956 received a COVID-19 positive diagnosis between 1/1/2020 and 9/16/2021. Median (IQR) age of the cohort was 63 (52-72) years, 76% of the cohort was female, 68% was non-Hispanic/Latinx White, and 73% was non-smokers. Prior to their first COVID-19 diagnosis, 364 patients were exposed to RTX. Compared to the use of csDMARDs, RTX use was associated with an increased odds of COVID-19-related hospitalization (adjusted odds ratio [aOR] 2.1, 95% confidence interval 1.5-3.0), ICU admission (aOR 5.2, 1.8-15.4) and invasive ventilation (aOR 2.7, 1.4-5.5). Results were confirmed in multiple sensitivity analyses.

Conclusion: Our findings can guide patients, providers, and policymakers regarding the increased risks associated with RTX use during the COVID-19 pandemic. These results can help risk stratification and prognosis-assessment.

Keywords: COVID-19; COVID-19 outcomes; Rheumatoid arthritis; Rituximab.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Antirheumatic Agents* / adverse effects
  • Arthritis, Rheumatoid* / complications
  • COVID-19 Testing
  • COVID-19*
  • Cohort Studies
  • Female
  • Humans
  • Middle Aged
  • Pandemics
  • Retrospective Studies
  • Rituximab / adverse effects

Substances

  • Rituximab
  • Antirheumatic Agents