Clinical Outcomes of CoVid-19 in Patients Taking Tumor Necrosis Factor Inhibitors and/or Methotrexate: A Multi-Center Research Network Study

Importance: Data on the impact of biologics and immunomodulators on CoVid-19 related outcomes remains scarce. Objective: Real-world evidence was used to determine whether patients on tumor necrosis factor inhibitor (TNFi) and/or methotrexate are at increased risk of worse CoVid-19 related outcomes. Design: In this large comparative cohort study, a real-time search and analysis were performed on patients diagnosed with CoVid-19 using the TriNetX (Cambridge, MA, USA) Research Network. Setting: TriNetX, a multi-center, global research network, provided real-time access to electronic medical records (EMR) for over 53 million patients from 42 healthcare organizations (HCOs). Participants: Adult patients (≥ 18 years old) with CoVid-19 specific diagnoses and terminology recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) were stratified into two groups, those taking a TNFi and/or methotrexate versus those who were not within 12 months of CoVid-19 diagnosis. Main Outcomes: Likelihood of hospitalization and mortality were compared between groups with and without propensity score matching for confounding factors. Results: 53,511,836 unique patient records were analyzed, of which 32,076 (0.06%) had a CoVid-19-related diagnosis documented starting after January 20, 2020. 214 patients with CoVid-19 were identified with recent TNFi or methotrexate exposure and were considered the treatment group, compared to 31,862 patients with CoVid-19 without TNFi or methotrexate exposure, the non-treatment group. After propensity matching, likelihood of hospitalization and mortality were not significantly different between the treatment and non-treatment group (risk ratio 0.91, 95% confidence interval [CI] 0.68-1.22, p=0.5260; risk ratio 0.87, 95% CI 0.42-1.78, p=0.6958, respectively). Conclusions and Relevance: Our study suggests that patients with recent TNFi and/or methotrexate exposure do not have increased hospitalization or mortality compared to CoVid-19 infected patients without recent TNFi and/or methotrexate exposure