COVID-19 in rheumatic disease patients on immunosuppressive agents

Abstract

To analyze clinical characteristics and outcome of COVID-19 patients with underlying rheumatic diseases (RD) on immunosuppressive agents. Method: A case series of COVID-19 patients with RD on disease modifying anti-rheumatic drugs (DMARDs) were studied by a retrospective chart review. A literature search identified 9 similar studies of single cases and case series, which were also included. Results: There were 4 COVID-19 inpatients with RD from our hospital, and the mean age was 57 § 21 years. Two patients had a mild infection, and 2 developed severe COVID-19 related respiratory complications, including 1 patient on secukinumab requiring mechanical ventilation and 1 patient on rituximab developing viral pneumonia requiring supplemental oxygenation. All 4 patients had elevated acute phase reactants, 2 patients had mild COVID-19 with lymphopenia, and 2 patients had severe COVID-19 with normal lymphocyte counts, and high levels of IL-6. None of the patients exhibited an exacerbation of their underlying RD. In the literature, there were 9 studies of COVID-19 involving 197 cases of various inflammatory RD. Most patients were on DMARDs or biologics, of which TNFa inhibitors were most frequently used. Two tocilizumab users had a mild infection. Two patients were on rituximab with 1 severe COVID-19 requiring mechanical ventilation. Six patients were on secukinumab with 1 hospitalization. Of the total 201 cases, 12 died, with an estimated mortality of 5.9% Conclusion: Patients with RD are susceptible to COVID-19. Various DMARDs or biologics may affect the viral disease course differently. Patients on hydroxychloroquine, TNFa antagonists or tocilizumab may have a mild viral illness. Rituximab or secukinumab could worsen the viral disease. Further study is warranted.

Major role of IgM in the neutralizing activity of convalescent plasma against SARS-CoV-2

“…Their use is associated with IgM deficiency in a substantial number of patients, while their impact on IgG and IgA levels is more limited (Kridin and Ahmed, 2020). In line with our data, recent studies reported that anti-CD20 therapy could be associated with a higher susceptibility to contract SARS-CoV-2 and develop severe COVID-19 (Guilpain et al, 2020;Hughes et al, 2020;Safavi et al, 2020;Schulze-Koops et al, 2020;Sharmeen et al, 2020;Sormani et al, 2020). Whether this is associated to the preferential depletion of IgM-producing B cells by these treatments (Looney et al, 2008) remains to be shown.…”

Autoinflammatory and autoimmune conditions at the crossroad of COVID-19

“…In contrast, those patients treated with Rituximab [137], or Secukinumab appeared to have worst outcome defined by a higher rate of ICU admissions [138]. Those patients treated with Rituximab and Secukinumab exhibited high concentrations of IL-6, suggesting that these medications failed to modulate IL-6 which has been strongly associated with mortality in COVID-19 [138]. In addition, CD20 blockers could impair B cells function hindering the production of NAbs against SARS-CoV-2 [138].…”

The Impact of Ambient Air Pollution Toward Coronavirus Disease 2019 (Covid19): A Literature Review

“…The pandemic condition caused Malaysia to lockdown various educational institutions, tourism, and others, so that it could indirectly have an impact on reducing air pollution by offset by local meteorological factors and anthropogenic emissions (60). In addition, in the YRD Region there was also a decrease in air pollution in SO 2 , NOx, PM 2,5 pollutants and Volatile Organic Compounds (VOCs) due to activity restrictions during the Covid19 pandemic (53).…”