Effect of anti-rheumatic drugs on the clinical outcome of autoimmune rheumatic diseases patients infected with COVID-19: A systemic review and meta-analysis

The immune deregulation and disease-modifying anti-rheumatic drugs (DMARDs) make patients with autoimmune rheumatic diseases (ARD) more susceptible to infection. We aimed to investigate the prevalence and clinical outcome of COVID-19 in ARD patients with different treatments. PubMed, Embase, Medline, Cochrane Library, Web of Science were searched to identify the relevant evidence up to March 20, 2023. The overall prevalence of COVID-19 in ARD patients was 0.061. The ARD patients with glucocorticoids (GC) treatment had the highest prevalence[0.088(95%CI:0.065-0.110)] compared to biological (b) DMARDs[0.041(95%CI:0.031-0.051)], conventional synthetic (cs) DMARDs[0.055(95%CI:0.043-0.067)], and anti-TNF therapy[0.029(95%CI:0.003-0.056)]. In contrast, those receiving anti-TNF therapy had the lowest prevalence. The overall hospitalization rate, ICU admission rate, and mortality of ARD patients due to COVID-19 were 0.402(95%CI:0.330-0.476), 0.077(95%CI:0.051-0.107), and 0.073(95%CI:0.046-0.104). Using bDMARDs had lower hospitalization rates[0.216(95%CI:0.147-0.286)], ICU admission rates[0.010(95%CI:0.000-0.037)], and mortality[0.039(95%CI:0.007-0.087)]. Regression analysis showed a significant negative relationship between bDMARDs monotherapy and ICU admission rates(regression coefficient:-0.156, 95%CI:-0.260 - -0.051, P=0.006). Patients using csDMARDs had higher hospitalization rates[0.607(95%CI:0.450-0.755)], ICU admission rates[0.055(95%CI:0.037-0.075)], and mortality[0.074(95%CI:0.041-0.114)]. Patients using GC had a higher hospitalization rate[0.703(95%CI:0.449-0.910)], higher ICU admission rate[0.094(95%CI:0.046-0.152)], and lower mortality[0.070(95%CI:0.033-0.114)]. Regression analysis showed a significant positive correlation between GC monotherapy and hospitalization(regression coefficient:0.484, 95%CI:0.146-0.822, P=0.006). For ARD patients, csDMARDs were associated with disease severity in COVID-19, bDMARDs were associated with a reduced risk of severe disease, and GC was effective in patients with severe COVID-19-related respiratory failure.