B-cell depletion with rituximab in the COVID-19 pandemic: where do we stand?

Mehta, Puja; Porter, Joanna C.; Chambers, Rachel C.; Isenberg, David; Reddy, Venkat

doi:10.1016/s2665-9913(20)30270-8

Cited by 68 publications

(64 citation statements)

References 5 publications

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“…Of particular interest in this regard is the effect of B-cell-depleting therapies in COVID-19, given its wide application in GN patients. 30 We also found no relationship between the use of RAASi at disease presentation and death or AKI risk, a finding that has been substantiated also in other populations. 2 , 31 , 32 , 33 Therefore, our data do not support the discontinuation of these medications in GN patients with COVID-19.…”

Section: Discussionsupporting

confidence: 57%

“…We can only speculate whether patients with GN practice better social distancing or if there is a potential “protective” role of certain immunosuppressive medications that prevents or limits the excessive immune activation responsible for severe clinical manifestations. 26 , 28 , 30 , 34 Thus far, there is no convincing evidence that any agents protect against severe COVID-19 infection, but these issues warrant further investigation.…”

Section: Discussionmentioning

confidence: 99%

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Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Waldman

Soler

García-Carro

et al. 2021

Kidney International

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The effects of SARS-CoV-2 infection on individuals with immune-mediated glomerulonephritis, who are often undergoing immunosuppressive treatments, are unknown. Therefore, we created the International Registry of COVID infection in glomerulonephritis (IRoc-GN) and identified 40 patients with glomerulonephritis and COVID-19 followed in centers in North America and Europe. Detailed information on glomerulonephritis diagnosis, kidney parameters, and baseline immunosuppression prior to infection were recorded, as well as clinical presentation, laboratory values, treatment, complications, and outcomes of COVID-19. This cohort was compared to 80 COVID-positive control cases from the general population without glomerulonephritis matched for the time of infection. The majority (70%) of the patients with glomerulonephritis and all the controls were hospitalized. Patients with glomerulonephritis had significantly higher mortality (15% vs. 5%, respectively) and acute kidney injury (39% vs. 14%) than controls, while the need for kidney replacement therapy was not statistically different between the two groups. Receiving immunosuppression or renin-angiotensin-aldosterone system inhibitors at presentation did not increase the risk of death or acute kidney injury in the glomerulonephritis cohort. In the cohort with glomerulonephritis, lower serum albumin at presentation and shorter duration of glomerular disease were associated with greater risk of acute kidney injury and need for kidney replacement therapy. No differences in outcomes occurred between patients with primary glomerulonephritis versus glomerulonephritis associated with a systemic autoimmune disease (lupus or vasculitis). Thus, due to the higher mortality and risk of acute kidney injury than in the general population without glomerulonephritis, patients with glomerulonephritis and COVID-19 should be carefully monitored, especially when they present with low serum albumin levels.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Waldman

Soler

García-Carro

et al. 2021

Kidney International

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“…Therefore, B-cell depletion could potentially compromise antiviral immunity, including the development of SARS-CoV-2 antibodies. 19 With our data, it was not possible to determine the exact timing of infection following rituximab infusion, although all patients were clinically judged by their rheumatologist to have been exposed to the immunological effects of the drug at the time of COVID-19 diagnosis. The association between rituximab and COVID-19-related death could have also been influenced by the typical coadministration of methylprednisolone with rituximab.…”

Section: Discussionmentioning

confidence: 96%

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

et al. 2021

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ObjectivesTo determine factors associated with COVID-19-related death in people with rheumatic diseases.MethodsPhysician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.ResultsOf 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66–75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.ConclusionAmong people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

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“…In those patients who are either smokers or seropositive, first-line therapy with Rituximab should be considered [43], while for seronegative patients, never smokers or those failing to respond to Rituximab, Tocilizumab has been recommended [44]. A recent review of the pros and cons of using Rituximab in COVID-19 argues that Rituximab should be reserved for a subset of patients with specific inflammatory complications because of the potential for reducing resistance to viral infection and the lymphopenia often consequent on such treatment [45]. However, this review suggests that where adaptive immunity might contribute to poor outcomes in COVID-19, Rituximab may well have a role.…”

Section: Short Commentarymentioning

confidence: 99%

There are similarities between rheumatic disease with lung involvement and COVID-19 pneumonia

Williamson

Black

et al. 2021

Ir J Med Sci

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Introduction There is considerable overlap between the clinical manifestations of covid-19 pneumonia and the acute interstitial lung disease seen in certain rheumatic disorders. In addition, pulmonary fibrosis is increasingly recognised as a potentially serious consequence of both. Methods This review explores this overlap of clinical features, risk factors and causation, offering insights into the immune mechanisms that contribute to both sets of disorders. Results The therapeutic role of immunosuppression and biologic agents in the treatment of covid-19 is explained in the light of this. Discussion We propose how lessons learned from the insights recently gained into each disorder can improve our insight into immunological mechanisms and application of therapeutic interventions in the other.

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B-cell depletion with rituximab in the COVID-19 pandemic: where do we stand?

Cited by 68 publications

References 5 publications

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

There are similarities between rheumatic disease with lung involvement and COVID-19 pneumonia

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