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Effect of treatment regimen of the rheumatoid arthritis patients on the risk of coronavirus disease 2019 by modulating the inflammatory mediators

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Abstract

Background

The therapeutic profile of the patients with rheumatoid arthritis (RA) commonly consists of immunosuppressive and anti-inflammatory compounds. Here in this research, we assessed the potential effect of drug treatment in the RA patients in increasing the risk of coronavirus disease 2019 (COVID-19) infection.

Methods

In this retrospective cross-sectional study, 200 subjects with RA were recruited. The treatment profile of the subjects for the past 6 months was collected. The COVID-19 diagnosis was implemented based on the standard molecular tests and clinical examinations. Serum concentration of cytokines was measured using enzyme-linked immunosorbent assay (ELISA).

Results

It was detected that there was an increased risk of COVID-19 in RA subjects receiving Etanercept (OR = 3.51, 95% CI 1.19–10.30, P = 0.022). Concentrations of Interleukin (IL)-1β, Interferon (IFN)-γ, Tumor necrosis factor (TNF)-α, IL-6, IL-17A, and IL-23 were significantly higher in the RA patients with COVID-19 relative to RA cases without COVID-19. In RA/COVID-19 cases receiving Etanercept, serum levels of TNF-α, IL-1β, and IL-6 were significantly lower than RA/COVID-19 subjects without Etanercept therapy.

Conclusions

It seems that Etanercept therapy in RA cases might increase proneness of the COVID-19 risk in these cases. The mechanism of this increased risk may stem from suppressing a protective immunity state in the RA cases.

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All data that support the conclusions of this manuscript are included within the article.

Abbreviations

RA:

Rheumatoid arthritis

COVID-19:

Coronavirus disease 2019

ELISA:

Enzyme-linked immunosorbent assay

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

ACE2:

Angiotensin-converting enzyme 2

ARDS:

Acute respiratory distress syndrome

IL:

Interleukin

TNF:

Tumor necrosis factor

ACR:

American College of Rheumatology

EULAR:

European Alliance of Associations for Rheumatology

DAS28:

Disease Activity Score 28

CT:

Computerized tomography

IFN:

Interferon

SPSS:

Statistical Package for the Social Sciences

OR:

Odds ratio

CI:

Confidence interval

SD:

Standard deviation

ESR:

Erythrocyte sedimentation rate

CRP:

C-reactive protein

RF:

Rheumatoid factor

Anti-CCP:

Anti-cyclic citrullinated peptide

NSAID:

Non-steroid anti-inflammatory drug

DMARD:

Disease-modifying antirheumatic drugs

Th:

Helper T

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Acknowledgements

The authors are grateful of the patients for their participation in this study.

Funding

This article was supported by a grant from Deputy of Research, Rafsanjan University of Medical Sciences.

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Authors and Affiliations

  1. Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

    Zahra Bagheri‑Hosseinabadi & Mitra Abbasifard

  2. Department of Clinical Biochemistry, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

    Zahra Bagheri‑Hosseinabadi

  3. Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

    Alireza Dehghani, Mohammad Amin Lotfi & Mitra Abbasifard

Authors
  1. Zahra Bagheri‑Hosseinabadi
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  2. Alireza Dehghani
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  3. Mohammad Amin Lotfi
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  4. Mitra Abbasifard
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Contributions

ZBH; Performed experiments, performed statistical analysis, participated in manuscript writing, and read the manuscript critically. AD; Participated in performing experiments, participated in manuscript writing, and read the manuscript critically. MAL; Participated in performing experiments, participated in manuscript writing, and read the manuscript critically. MA; Developed the main idea, performed patient examination, promoted the study conceptualization, participated in manuscript writing, and read the manuscript critically.

Corresponding author

Correspondence to Mitra Abbasifard.

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The authors declare that they have no competing interests.

Ethical approval

This study was approved by the ethics committee of Rafsanjan University of Medical Sciences (IR.RUMS.REC.1401.187).

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Bagheri‑Hosseinabadi, Z., Dehghani, A., Lotfi, M.A. et al. Effect of treatment regimen of the rheumatoid arthritis patients on the risk of coronavirus disease 2019 by modulating the inflammatory mediators. Inflammopharmacol 31, 3021–3028 (2023). https://doi.org/10.1007/s10787-023-01289-8

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