Association of immunomodulatory therapies with COVID-19 mortality in rheumatoid arthritis: An analysis of the FDA adverse event reporting system

Background: The COVID-19 pandemic significantly affects patients with RA and other rheumatic diseases. Our study aims to explore the factors associated with COVID-19-related fatality among Rheumatoid Arthritis (RA) patients, especially immunomodulatory therapies, using the international Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). Methods: Reportes from FAERS were extracted from February 2020 to September 2022, and uesd for this cross-sectional analysis. The investigative outcome was COVID-19-related death. Age, sex, region, event date, and immunomodulatory medications classies were included as co-variates in multivariable logistic regression. In view of the different targeting and affinity of individual JAKi, Tofacitinib, Upadacitinib and Baricitinib was respectively analyzed. Results: In all, 3808 cases (mean age 58.85 years, 82.8% female), 267 (7.0%) died. JAKi therapies (41.2%), followed by TNFi (37.7%), IL-1i (12.2%), IL-6i (4.1%) and Anti-CD20 (3%) were reported. Risk factors associated with COVID-19-related death in RA patients were age (odds ratio [OR]: 1.06; 95% confidence interval [CI]: 1.05–1.08; p ​< ​0.01), male sex (1.71, 1.26–2.33; p ​= ​0.01) and anti-CD20 therapies (5.05; 1.40–18.19; p ​= ​0.013). With TNFi conference, anti-CD20 was still a risk predictor (4.29; 2.39–7.70; p ​< ​0.01). Other DMARDs except for anti-CD20, did not confer a significant association with mortality, compared with csDMARDs or TNFi. Individual JAKi showed no obvious difference in the risk of death, compared with csDMARDs or TNFis. Conclusions: Conclusions Using FAERS open access data for risk prediction of death, anti-CD20 therapies were recognized as a risk factor for COVID-19-related fatalities among RA patients, other immunomodulatory therapies were not associated with mortality, compared with csDMARDs or TNFis.