TNF-alpha Blockers Showed Prophylactic Effects in Preventing COVID-19 in Patients with Rheumatoid Arthritis and Seronegative Spondyloarthropathies: A Case-Control Study

Abstract

Introduction: The interaction between angiotensin-converting enzyme 2 (ACE2) and SARSCoV-2 is a crucial factor in the viral infections leading to the release of inflammatory proteins, such as TNF-alpha. Thus, it is hypothesized that TNF-alpha blockers can prevent either COVID-19 incidence or its serious symptoms. TNF-alpha blockers are prescribed to treat various autoimmune disorders, including rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA). Therefore, the objective of this work was to examine this hypothesis that TNF-alpha blockers can prevent COVID-19 incidence in patients with RA or SpA. Methods: A case-control study was conducted through interviews based on a structured questionnaire to investigate the frequency of COVID-19 incidence in 254 eligible patients with RA or SpA about whom 45 were under treatment with one type of TNF-alpha blockers including infliximab, adalimumab, and etanercept at least for 3 months during the COVID-19 pandemic. Interviews were carried out twice, at the beginning and the end of the study (June-December 2020). Patients with COVID-19 during the study or before that were considered as cases. The control group was patients without COVID-19 experience. Data were analyzed using descriptive statistics, and logistic regression was used to determine the relationships between COVID-19 incidence and independent variables. Results: A small percentage of patients treated with TNF-alpha blockers (5.22, 6/115) experienced COVID-19, while a large percentage of patients with COVID-19 did not receive TNF-alpha blockers (27.34, 38/139). According to odds ratio, adalimumab, infliximab, and etanercept decreased significantly the risk of developing COVID-19 up to 96.8, 95, and 80.3 (p < 0.05), respectively. Therefore, TNF-alpha blockers could probably decrease the chances of the COVID-19 incidence in patients with RA or SpA. Conclusions: A direct and positive correlation between the use of TNF-alpha blockers and a reduction in the incidence of COVID-19 could suggest the prophylactic role of these drugs in preventing COVID-19 in patients with RA and SpA.