# The Impact of Disease-Modifying Antirheumatic Drugs on In-Hospital Outcomes of Patients With COVID-19: A Retrospective Cohort Study and Literature Review

## TL;DR

This study found no significant differences in hospital outcomes for patients with autoimmune diseases taking DMARDs versus those who weren't, when they contracted COVID-19.

## Contribution

The study provides new evidence on the safety of DMARDs in hospitalized patients with COVID-19.

## Key findings

- DMARD use was not associated with statistically significant differences in mortality rates.
- Patients on DMARDs showed trends toward better outcomes, though not statistically significant.
- Baseline characteristics were similar between DMARD and non-DMARD groups.

## Abstract

Objective

Disease-modifying antirheumatic drugs (DMARDs) are widely used to treat autoimmune diseases. However, little is known regarding whether they influence in-hospital outcomes in patients admitted with COVID-19.

Methods

A retrospective cohort study was conducted in two Las Vegas, Nevada, tertiary referral hospitals to evaluate whether the use of DMARD in patients with COVID-19 influences in-hospital outcomes. Data were retrieved from electronic health records of adult patients with COVID-19 who were admitted over six months. Patients were divided into two groups: those who were actively receiving DMARD therapy when they developed COVID-19 (n = 14) and those who were not (n = 553). Primary (mortality rates) and secondary endpoints (type of visit (emergency department versus inpatient admission), need for mechanical ventilation, ICU upgrades, and length of hospital stay) were compared among the two groups.

Results

The two groups had similar baseline characteristics such as age, sex, race, body mass index, and ethnicity. Although differences existed between the groups’ outcomes, these differences were not statistically significant. Mortality rates (p = 0.36), emergency room visit rates ( p = 0.14), ICU admission rate (p = 0.8), total length of hospital stay (8 days vs. 2.8 days, p = 0.2), and ventilator use (p = 0.5) were not statistically significant when comparing the DMARD and non-DMARD groups.

Conclusion

Our study indicates that both non-DMARD and DMARD groups had similar outcomes after contracting COVID-19 without any statistically significant differences. Although not statistically significant, the observation of reduced mortality, admissions, and ventilator use in the DMARD group compared to the non-DMARD group is hypothesis-generating and should be explored in future studies.