Some Arthritis Meds Raise Risks in Latest COVID Spike

Most people experience mild symptoms, but patients who take JAK inhibitors are at higher risk of worse outcomes.

By Linda Rath | updated January 12, 2024

This winter, like the past three, has seen a spike in COVID-19 infections and hospitalizations. The current culprit is a subvariant called JN.1, which now accounts for most cases in the U.S., according to CDC tracking data. JN.1 has a mutation that makes it easier to evade the immune system and seems particularly good at hiding in the gut.

So far, new infections haven’t increased as much as in past years, and most people are reporting milder symptoms. The risk of hospitalization is also less but trending upwards. In the U.S., 1,200 people still die every week from COVID, and many more may develop long-term complications

Experts predicted a winter surge. Cold weather sends people indoors, and many travel and attend big gatherings over the holidays. People have also pretty much given up mask-wearing, doctors say, and few have gotten the updated COVID-19 vaccine. The shots may not prevent infection but can help protect against hospitalization and death. 

Experts say people who are immunocompromised or take medications that weaken the immune system should take extra precautions, including wearing a high-quality mask in crowded public spaces or large groups, testing and treating with Paxlovid if infected, washing their hands thoroughly and often and staying home when sick. According to the National Institutes of Health, concerns about rebound COVID shouldn’t stop people from taking Paxlovid, since it has proved effective at preventing hospitalization and death.

People who have rheumatoid arthritis (RA) treated with Janus kinase (JAK) inhibitors need to be especially careful.

According to a study published in Rheumatic and Musculoskeletal Diseases in July 2023, patients taking these drugs are significantly more likely to be hospitalized or have poor outcomes, including mortality, compared to those treated with an interleukin-6 (IL-6) inhibitor like tocilizumab (Actemra) or a tumor necrosis factor (TNF) blocker, such as adalimumab (Humira or one of its biosimilars) or etanercept (Enbrel).
Researchers used data from TriNetX, the largest global COVID-19 real-time database. It showed that the incidence of coronavirus infection didn’t vary much among patients on different types of arthritis drugs. But people treated with JAK inhibitors who became infected were nearly twice as likely to be hospitalized and one-and-one-half times more likely to die. 

Outcomes were even worse for patients taking JAK inhibitors who are not vaccinated.

The researchers strongly recommend the updated COVID-19 vaccine for people taking a JAK inhibitor or rituximab (Rituxan), which in an earlier study were associated with a greater than quadrupled risk of hospitalization and death.

The government has handed over the distribution of the new shots to the three U.S. vaccine makers, so they may not be as readily available as before. And the government will no longer be buying them. But Medicare and commercial insurance plans are required to cover them, and updated boosters will be free for the uninsured and adults and children on Medicaid for one year. The intent is that consumers will not have to shoulder much of the cost. 

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