Background: Prevalence and outcomes of Coronavirus Disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the
This potentially informative article with some methodological flaws suggests that glucocorticoids are associated with increased COVID-19 risk among patients with chronic inflammatory arthritis. Patients treated with Disease-Modifying Drugs (DMARDS) were at reduced risk.
RR:C19 Evidence Scale rating by reviewer:
Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.
The rheumatology community has had concerns about the use of immunosuppressive treatment during the outbreak of COVID-19. This manuscript is a valid study about the use of chronic glucocorticoids and immunomodulating therapies in rheumatic patients on the incidence of COVID-19. The use of biologic agents such as IL-1, IL-6, and JAK inhibitors has been questioned in treating patients infected by COVID-19. The use of glucocorticoids has also been questioned by several authors. Some have determined that the use of glucocorticoids could have a negative effect on virus replication, and some have argued that it could be beneficial on hyper-inflammation associated with COVID-19.
Recently, several guidelines have recommended the use of dexamethasone in COVID-19.
1) What is the author’s opinion on the use of dexamethasone in COVID-19? This should be discussed since several recent guidelines have included the use of DXM.
2) Has any of the hospitalized patients been treated with glucocorticoids? Or with IL-6 and IL-1 inhibitors?
Several studies have proved that the use of biologic agents could protect from inflammation associated with SARS-CoV2 and many have not proved the benefit of using HCQ.