Rheumatology Drugs Explored for COVID-19 in the Spotlight

Maureen Salamon

May 29, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

First results from a database of adults and children with rheumatic and musculoskeletal diseases who have contracted COVID-19 will be unveiled at the upcoming virtual European League Against Rheumatism (EULAR) 2020 Congress.

Loreto Carmona

The database, which is updated weekly, will enable clinicians to compare treatment and disease outcomes in patients and to analyze predictive factors for poor prognoses, said Loreto Carmona, MD, PhD, from the Musculoskeletal Health Institute in Madrid, who is chair of the EULAR abstract selection committee.

As of May 26, a total of 985 patients from 28 participating countries had been entered in the EULAR COVID-19 database, which was launched as part of the Global Rheumatology Alliance. Patient data are categorized by factors such as top rheumatology diagnosis, comorbidities, top-five COVID-19 symptoms, and disease-modifying anti-rheumatic drug (DMARD) therapy at time of virus infection. Anonymized data will be shared with an international register based in the United States.

In addition to the "many questions" about which immunomodulatory drugs can make patients with rheumatic and musculoskeletal diseases more vulnerable to the virus, rheumatologists and patients also want to know if any standard therapies can prevent the cytokine storms that are a severe complication of the disease, Carmona explained.

"There are also questions about whether some of our treatments are actually masking the disease, or if we might have complications or different safety events because of that," she told Medscape Medical News.

"This crisis is going scarily fast," Carmona pointed out. "Some of the answers are not really complete and we are still waiting for some good clinical trials, but we suspect that some of the DMARD medications are actually playing a good part in this disease."

Risks and Safeguards

"There are real implications for our patients," said John Isaacs, MBBS, PhD, from Newcastle University in Newcastle Upon Tyne, United Kingdom, who is chair of the EULAR scientific program committee. "We can't make assumptions — we have to do trials — but the answers to these questions will determine the lifestyles of our patients and the decisions they make."

John Isaacs

"COVID-19 is a very interesting situation for all sorts of reasons, and not least because a lot of the drugs we use in rheumatology are being investigated as potential treatments for severe COVID," he told Medscape Medical News.

"That means our community has had quite a lot of input into COVID, and patients want to know if they are at risk for it or, conversely, if they may be safeguarded because of some treatment they're receiving," he said.

The many sessions scheduled for the original meeting remain dedicated to research on treatment options for rheumatoid arthritis, lupus, scleroderma, and other rheumatic and musculoskeletal diseases, but much of the focus has naturally shifted to COVID-19, the organizers said.

As it has in typical years, the meeting will be dominated by research on rheumatoid arthritis, especially into potential new targets. Several noteworthy abstracts will home in on thrombosis risk related to inflammatory arthritis treatments, Isaacs reported.

Another abstract will focus on opioid analgesic consumption in patients also taking TNF inhibitors. This will be interesting because "I know there's some concern about the amount of opioid use in people with arthritis right now," he added.

European League Against Rheumatism (EULAR) 2020 Congress.

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