TNFI, methotrexate safe to use in COVID-19 patients

Tumour necrosis factor inhibitors (TNFI) and methotrexate do not appear to worsen outcomes among patients with the novel coronavirus disease (COVID-19), a new study has shown.

The large comparative cohort study included 32,076 recently diagnosed COVID-19 patients, of whom 214 (mean age, 55.1±15.8 years; 66.4 percent female) had recent TNFI or methotrexate use. Participants were followed for 45 days after the index event, during which the primary outcome of hospitalization and mortality, from any cause, was recorded.

Propensity score matching led to 213 participants each in the TNFI/methotrexate and control groups; characteristics such as age, sex, race, and comorbidities were well-balanced after matching.

The risk of hospitalization was comparable between patients who were vs were not on TNFI/methotrexate (risk ratio [RR], 0.91, 95 percent confidence interval [CI], 0.68–1.22; p=0.5260).

This null interaction remained true even when focusing on subgroups treated with TNFI alone (RR, 0.73, 95 percent CI, 0.47–11.4; p=0.1594) or methotrexate alone (RR, 0.87, 95 percent CI, 0.62–1.23; p=0.4272).

Similarly, death risk was not significantly elevated among patients who were on TNFI/methotrexate as compared to controls (RR, 0.87, 95 percent CI, 0.42–1.78; p=0.6958).

“Because the COVID-19 pandemic is ongoing, there is desperate need for evidence-based data on biologic and immunomodulator exposure in the setting of COVID-19 infection,” the researchers said.

“Current guidelines regarding COVID-19 and biologic use are largely based on expert opinion rather than rigorous statistical analysis. Our study supports the ongoing use of TNFi and/or methotrexate therapy and argues against interruption of treatment owing to fear of possibly worse COVID-19 related outcomes,” they added.