COVID-19 Outcomes in Patients Undergoing B Cell Depletion Therapy and Those with Humoral Immunodeficiency States: A Scoping Review

Abstract

Background: The role of humoral immunity has been well established in reducing infection risk and facilitating viral clearance in patients with COVID-19. However, the relationship between specific antibody responses and severity of COVID-19 is less well understood. Methods: To address this question and identify gaps in knowledge, we utilized the methodology of a scoping review to interrogate risk of infection and clinical outcomes of COVID-19 in patients with iatrogenic and inborn humoral immunodeficiency states based on existing literature. Results: Among patients with iatrogenic B-cell depletion, particularly with agents targeting CD20, our analysis found increased risk of severe COVID-19 and death across a range of underlying disease states. Among patients with humoral inborn errors of immunity with COVID-19, our synthesis found that patients with dysregulated humoral immunity, predominantly common variable immunodeficiency (CVID), may be more susceptible to severe COVID-19 than patients with humoral immunodeficiency states due to X-linked agammaglobulinemia and other miscellaneous forms of humoral immunodeficiency. There were insufficient data to appraise the risk of COVID-19 infection in both populations of patients. Conclusions: Our work identifies potentially significant predictors of COVID-19 severity in patients with humoral immunodeficiency states and highlights the need for larger studies to control for clinical and biologic confounders of disease severity.

COVID-19 Outcomes Among Users of CD20 Inhibitors for Immune-Mediated Diseases: A Comparative Cohort Study

“…Anti-CD20 monoclonal antibodies such as rituximab and ocrelizumab are used to treat immune-mediated autoimmune diseases including rheumatoid arthritis, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, and multiple sclerosis, among other conditions. CD20 inhibitors cause elimination of circulating pre-B and B-cells, which results in an impaired immune response to COVID-19 (7,8).…”

Coronavirus Disease 2019 (COVID-19) and Immune-mediated Rheumatic Diseases. Recommendations of the Association of Rheumatologists of Russia

“…Научно обоснованные рекомендации о приоритетном использовании определенных противовоспалительных препаратов (или схем лечения) в период пандемии COVID-19 в настоящее время не сформулированы. С учетом российской клинической практики следует обратить внимание на относительные противопоказания назначения РТМ [60,[110][111][112][113][114][115], лечение которым в условиях пандемии COVID-19 должно проводиться с особой осторожностью и только по строгим показаниям. Кроме того, следует акцентировать внимание на возможных преимуществах ингибиторов ФНО-α, применение которых у пациентов с ИВРЗ ассоциируется с более «мягким» течением COVID-19 [59,73].…”

B cell depletion in immune-mediated rheumatic diseases and coronavirus disease 2019 (COVID-19)

“…Данные литературы свидетельствуют о том, что деплеция В-клеток c использованием РТМ и других анти-Вклеточных препаратов у пациентов с ИВРЗ, заболевших COVID-19, в большинстве случаев ассоциируется с повышенной предрасположенностью к инфекции SARS-CoV-2 и тяжелому течению COVID-19 [69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87] (табл. 3).…”