COVID-19 in Autoinflammatory Diseases with Immunosuppressive Treatment

Abstract

COVID-19 disease increases interleukin (IL)-1β release. Anti-IL-1-treatment is effective in IL-1-mediated autoinflammatory diseases (AID). This case series presents COVID-19 in patients with IL-1-mediated and unclassified AID with immunosuppressive therapy (IT). Patient 1 is a 34-year-old woman with an unclassified AID and methotrexate. Patients 2 and 3 (14-year-old girl and 12-year-old boy, respectively) have a Cryopyrin-Associated Periodic Syndrome (NLRP3 p.Q703K heterozygous, CAPS) treated with canakinumab 150 mg/month since three and five years, respectively. Patient 4 is a 15-year-old girl who has had familial Mediterranean fever (MEFV p.M694V homozygous) for 3 years treated with canakinumab 150 mg/month and colchicine. All patients had a mild acute COVID-19 course, particularly the adolescent patients. A few weeks after COVID-19 recovery, both CAPS patients developed increased AID activity, necessitating anti-IL-1-treatment intensification in one patient. At day 100, one out of four patients (25%) showed positive antibody response to SARS-CoV-2. This is one of the first reports providing follow-up data about COVID-19 in AID. The risk for severe acute COVID-19 disease was mild/moderate, but increased AID activity post-COVID-19 was detected. Follow-up data and data combination are needed to expand understanding of COVID-19 and SARS-CoV-2 immunity in AID and the role of IT.

Purpuric lesions on the eyelids developed after BNT162b2 mRNA COVID‐19 vaccine: another piece of SARS‐CoV‐2 skin puzzle?

“…In addition, superficial administration of vaccines more likely causes local side effects. 3 Obese individuals are at greater risk for severe SARS-CoV-2 infection and seem to generate poorer humoral vaccination responses compared with normal-weight persons. 4 Therefore, correct administration of SARS-CoV-2 vaccines is essential in the obese population.…”

“…After the launch of vaccination campaign, several new potential adverse events have been reported both with BNT162b2 mRNA and ChAdOx1 adenovirus vaccine. In particular, BNT162b2 mRNA vaccine has been associated both with symptomatic and asymptomatic thrombocytopenia, 3 while ChAdOx1 with several cases of a new, life-threatening, thrombotic thrombocytopenic disease resembling the heparin-induced thrombocytopenia, for which the new term vaccine-induced thrombocytopenic thrombosis (VITT) has been proposed. 4 Besides, in severe cases of COVID-19 microthrombotic phenomenon is considered at the basis of the multiorgan microangiopathy associated with the SARS-CoV-2 infection, so that heparin is now one of the cornerstones of severe COVID-19 treatment.…”

Lockdown effects on a patient receiving immunosuppression for unilateral HLA- B27 associated uveitis during COVID-19 pandemic

“…There is definitely a role of immunosuppression in treating Post COVID-19 patients with ocular hyperinflammatory status. [ 9 10 ]…”

Autoinflammatory Diseases and Cytokine Storms—Imbalances of Innate and Adaptative Immunity

“…To support these conclusions, indeed, it is notable that AIFA (Italian Medicines Agency) has recently authorized anakinra, an anti-IL-1β drug (already used for rheumatoid arthritis) for the treatment of patients affected by COVID-19, and other studies confirmed the efficacy of biologic drugs for the early comparison to COVID-19 clinical manifestation [ 199 , 200 , 201 ].…”