TY - JOUR
T1 - Antirheumatic Disease Therapies for the Treatment of COVID-19
T2 - A Systematic Review and Meta-Analysis
AU - the COVID-19 Global Rheumatology Alliance
AU - Putman, Michael
AU - Chock, Yu Pei Eugenia
AU - Tam, Herman
AU - Kim, Alfred H.J.
AU - Sattui, Sebastian E.
AU - Berenbaum, Francis
AU - Danila, Maria I.
AU - Korsten, Peter
AU - Sanchez-Alvarez, Catalina
AU - Sparks, Jeffrey A.
AU - Coates, Laura C.
AU - Palmerlee, Candace
AU - Peirce, Andrea
AU - Jayatilleke, Arundathi
AU - Johnson, Sindhu R.
AU - Kilian, Adam
AU - Liew, Jean
AU - Prokop, Larry J.
AU - Murad, M. Hassan
AU - Grainger, Rebecca
AU - Wallace, Zachary S.
AU - Duarte-García, Alí
N1 - Publisher Copyright:
© 2020, American College of Rheumatology
PY - 2021/1
Y1 - 2021/1
N2 - Objective: Antirheumatic disease therapies have been used to treat coronavirus disease 2019 (COVID-19) and its complications. We conducted a systematic review and meta-analysis to describe the current evidence. Methods: A search of published and preprint databases in all languages was performed. Included studies described ≥1 relevant clinical outcome for ≥5 patients who were infected with severe acute respiratory syndrome coronavirus 2 and were treated with antirheumatic disease therapy between January 1, 2019 and May 29, 2020. Pairs of reviewers screened articles, extracted data, and assessed risk of bias. A meta-analysis of effect sizes using random-effects models was performed when possible. Results: The search identified 3,935 articles, of which 45 were included (4 randomized controlled trials, 29 cohort studies, and 12 case series). All studies evaluated hospitalized patients, and 29 of the 45 studies had been published in a peer-reviewed journal. In a meta-analysis of 3 cohort studies with a low risk of bias, hydroxychloroquine use was not significantly associated with mortality (pooled hazard ratio [HR] 1.41 [95% confidence interval (95% CI) 0.83, 2.42]). In a meta-analysis of 2 cohort studies with some concerns/higher risk of bias, anakinra use was associated with lower mortality (pooled HR 0.25 [95% CI 0.12, 0.52]). Evidence was inconclusive with regard to other antirheumatic disease therapies, and the majority of other studies had a high risk of bias. Conclusion: In this systematic review and meta-analysis, hydroxychloroquine use was not associated with benefit or harm regarding COVID-19 mortality. The evidence supporting the effect of other antirheumatic disease therapies in COVID-19 is currently inconclusive.
AB - Objective: Antirheumatic disease therapies have been used to treat coronavirus disease 2019 (COVID-19) and its complications. We conducted a systematic review and meta-analysis to describe the current evidence. Methods: A search of published and preprint databases in all languages was performed. Included studies described ≥1 relevant clinical outcome for ≥5 patients who were infected with severe acute respiratory syndrome coronavirus 2 and were treated with antirheumatic disease therapy between January 1, 2019 and May 29, 2020. Pairs of reviewers screened articles, extracted data, and assessed risk of bias. A meta-analysis of effect sizes using random-effects models was performed when possible. Results: The search identified 3,935 articles, of which 45 were included (4 randomized controlled trials, 29 cohort studies, and 12 case series). All studies evaluated hospitalized patients, and 29 of the 45 studies had been published in a peer-reviewed journal. In a meta-analysis of 3 cohort studies with a low risk of bias, hydroxychloroquine use was not significantly associated with mortality (pooled hazard ratio [HR] 1.41 [95% confidence interval (95% CI) 0.83, 2.42]). In a meta-analysis of 2 cohort studies with some concerns/higher risk of bias, anakinra use was associated with lower mortality (pooled HR 0.25 [95% CI 0.12, 0.52]). Evidence was inconclusive with regard to other antirheumatic disease therapies, and the majority of other studies had a high risk of bias. Conclusion: In this systematic review and meta-analysis, hydroxychloroquine use was not associated with benefit or harm regarding COVID-19 mortality. The evidence supporting the effect of other antirheumatic disease therapies in COVID-19 is currently inconclusive.
UR - http://www.scopus.com/inward/record.url?scp=85090870028&partnerID=8YFLogxK
U2 - 10.1002/art.41469
DO - 10.1002/art.41469
M3 - Article
C2 - 32741139
AN - SCOPUS:85090870028
SN - 2326-5191
VL - 73
SP - 36
EP - 47
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
IS - 1
ER -