Correspondence on ‘Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: case–control study’

Winkler, Martin Sebastian; Korsten, Peter; Binder, Claudia R.; Tampe, Björn

doi:10.1136/annrheumdis-2020-218836

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…Moreover, vaccination is a strong stimulator of the immune system, coordinating a humoral and cellular adaptive immunity to polarize a vaccine-induced T cell response, also reported for SARS-CoV-2 vaccines ( 32 ). Vaccine-induced reactivation of CMV may have similarities with immune reconstitution inflammatory syndrome (IRIS) characterized by a paradoxical worsening of preexisting infection due to a reconstituted capacity for an inflammatory response following the initiation of antiretroviral therapy (ART), also reported in COVID-19 ( 33 , 34 ). In addition, CMV reactivation is known to trigger an inflammatory response often persisting in COVID-19 patients long after SARS-CoV-2 is no longer detectable, which might be relevant for patients with long COVID that still have symptoms months after SARS-CoV-2 infection ( 35 , 36 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Cytomegalovirus Reactivation and Pericarditis Following ChAdOx1 nCoV-19 Vaccination Against SARS-CoV-2

et al. 2022

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As the coronavirus disease 2019 (COVID-19) pandemic is ongoing and new variants of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are emerging, there is an urgent need for vaccines to protect individuals at high risk for complications and to potentially control disease outbreaks by herd immunity. Surveillance of rare safety issues related to these vaccines is progressing, since more granular data emerge about adverse events of SARS-CoV-2 vaccines during post-marketing surveillance. Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) reactivation has already been reported in COVID-19 patients. In addition, adverse events after SARS-CoV-2 mRNA vaccination have also been in the context of varicella zoster virus (VZV) reactivation and directly associated with the mRNA vaccine. We present the first case of CMV reactivation and pericarditis in temporal association with SARS-CoV-2 vaccination, particularly adenovirus-based DNA vector vaccine ChAdOx1 nCoV-19 against SARS-CoV-2. After initiation of antiviral therapy with oral valganciclovir, CMV viremia disappeared and clinical symptoms rapidly improved. Since huge vaccination programs are ongoing worldwide, post-marketing surveillance systems must be in place to assess vaccine safety that is important for the detection of any events. In the context of the hundreds of millions of individuals to be vaccinated against SARS-CoV-2, a potential causal association with CMV reactivation may result in a considerable number of cases with potentially severe complications.

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Section: Discussionmentioning

confidence: 99%

Case Report: Cytomegalovirus Reactivation and Pericarditis Following ChAdOx1 nCoV-19 Vaccination Against SARS-CoV-2

et al. 2022

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“…Another concern during the pandemic has been the impact of basal ISTs (CS, antimalarials, and DMARDs) on the prognosis of COVID-19. The onset of hyper-inflammatory syndromes and even immune reconstitution inflammatory syndrome associated with poor prognosis have been described in the course of SARS-CoV-2 infection [ 48 ]. Immunosuppressive therapies have been used for the treatment of this inflammatory phase of the disease [ 24 , 49 ], similar to other ADs associated with viral infections (such as cryoglobulinemia and hepatitis C virus or polyarteritis nodosa and hepatitis B virus [ 50 ]).…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry

Ayala-Gutiérrez

Rubio‐Rivas

Gómez

et al. 2021

JCM

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(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects.

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“…1 In conclusion, we here confirm that risk stratification for COVID-CS is also predictive in an independent cohort of critically ill patients with severe COVID-19, highlighting the relevance of hyperinflammation and tissue damage associated with disease severity and COVID-19 mortality as reported previously. [3][4][5][6]…”

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confidence: 99%

Correspondence on ‘Preliminary predictive criteria for COVID-19 cytokine storm’

et al. 2021

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Correspondence on ‘Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: case–control study’

Cited by 7 publications

References 17 publications

Case Report: Cytomegalovirus Reactivation and Pericarditis Following ChAdOx1 nCoV-19 Vaccination Against SARS-CoV-2

Case Report: Cytomegalovirus Reactivation and Pericarditis Following ChAdOx1 nCoV-19 Vaccination Against SARS-CoV-2

Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry

Correspondence on ‘Preliminary predictive criteria for COVID-19 cytokine storm’

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