Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Curr Rheumatol Rep. 2021 Apr 24;23(5):28. doi: 10.1007/s11926-021-00998-9.
Patients on disease-modifying anti-rheumatic drugs (DMARDs) remain concerned about potential risks of severe COVID-19 outcomes. Meanwhile, several DMARDs have been proposed as COVID-19 therapies.
In patients with autoimmune diseases, baseline glucocorticoid use is associated with severe COVID-19. While classes of DMARDs (e.g., conventional synthetic, targeted synthetic, and biologic) do not appear to be associated with higher risk, specific medications such as rituximab and sulfasalazine may be associated. Randomized clinical trials (RCTs) show that glucocorticoids reduce mortality in severe COVID-19. RCTs suggest other agents, such as baricitinib, may improve COVID-19 outcomes in certain populations. Baseline glucocorticoid use raises the risk of severe COVID-19 in patients with autoimmune diseases, but glucocorticoids are an effective treatment for those with severe COVID-19. Further research is needed to inform DMARD management in autoimmune disease patients during the pandemic and the role of DMARDs in COVID-19 treatment.
接受疾病修正抗风湿药物（DMARDs）治疗的患者仍对罹患严重 COVID-19 的潜在风险感到担忧。与此同时，一些 DMARDs 已被提议作为 COVID-19 的治疗药物。
在患有自身免疫性疾病的患者中，基线糖皮质激素的使用与严重 COVID-19 相关。虽然 DMARDs 类别（如传统合成物、靶向合成物和生物制剂）似乎与更高的风险无关，但某些药物，如利妥昔单抗和柳氮磺胺吡啶，可能与更高的风险相关。随机临床试验（RCT）表明，糖皮质激素可降低严重 COVID-19 的死亡率。RCT 表明，巴利昔替尼等其他药物可能可改善某些人群的 COVID-19 结局。基线糖皮质激素的使用增加了患有自身免疫性疾病的患者罹患严重 COVID-19 的风险，但糖皮质激素是治疗严重 COVID-19 的有效药物。需要进一步的研究来为大流行期间自身免疫性疾病患者的 DMARD 管理和 DMARDs 在 COVID-19 治疗中的作用提供信息。
