Figure 5 :The effect of anti-rheumatic drugs on the clinical outcomes of autoimmune rheumatic diseases from the perspective of the main drugs. (1)The hospitalization rates of ARD patients after using anti-rheumatic drugs. (A) GC, (B) bDMARDs, (C) csDMARDs, (D) anti-TNF therapy. (2)The ICU admission rates of ARD patients after using anti-rheumatic drugs. (E) GC, (F) bDMARDs, (G) csDMARDs, (H) anti-TNF therapy. (3)The mortality of ARD patients after using anti-rheumatic drugs. (I) GC, (J) bDMARDs, (K) csDMARDs, (L) anti-TNF therapy.
From the perspective of major drugs, the ICU admission rates of ARD patients using GC, bDMARDs, csDMARDs, and anti-TNF therapy were 0.094(95%CI:0.046-0.152), 0.010(95%CI:0.000-0.037), 0.055(95%CI:0.037-0.075) and 0.022(95%CI:0.000-0.081)(Figure 5). The ICU admission rates of patients using bDMARDs, csDMARDs and anti-TNF therapy was lower than the total ICU rate. The mortalities in ARD patients mainly using GC, bDMARDs, csDMARDs, and anti-TNF therapy were 0.070(95%CI:0.033-0.114), 0.039(95%CI:0.007-0.087), 0.074(95%CI:0.041-0.114) and 0.068(95%CI:0.034-0.111)(Figure 5). Regression analysis showed that the main use of major drugs was not associated with the ICU admission and mortality(Figure p14 and p15).
Since the effect of drugs on clinical outcomes is different in different diseases, we performed a more detailed stratification. We only selected the studies in which patients using a certain drug exceeded 50% of the total cases. In SLE, the hospitalization rates of patients mainly using GC and csDMARDs were 0.670(95%CI:0.406-0.933) and 0.575(95%CI:0.434-0.716). The mortality due to COVID-19 in these patients mainly using GC was 0.055(95%CI:0.045-0.065). The hospitalization rate of SLE patients using GC was higher than those using DMARDs. The hospitalization rates of RA patients mainly using GC and csDMARDs were both 0.563(95%CI:0.192-0.934). The mortality of these patients mainly using GC and csDMARDs were 0.077(95%CI:0.035-0.120) and 0.059(95%CI:0.022-0.109), respectively, the mortality of RA patients using GC was higher than those of csDMARDs. The hospitalization rates of CTD patients mainly using csDMARDs was 0.466(95%CI:0.007-0.974)(Figure p16).