Incidence and severity of COVID-19 in patients with autoimmune blistering skin diseases: A nationwide study

Joly, P.; Gillibert, André; Bohelay, G.; Aouar, Karen; Ingen‐Housz‐Oro, Saskia; Bédane, C.; Lepelletier, C.; Bohin, Emmanuelle Tancrède; Viguier, Manuelle; Dupin, Nicolas; Debarbieux, S.; Jullien, D.; Quéreux, G.; Morice, C.; Mahé, A.; Michel, Catherine; Litrowski, N.; Jeudy, G.; Richard, M.‐A.; Picard, Catherine; Chosidow, Olivier; Ledard, Anne-Pham; Hébert, V.; Duvert‐Lehembre, S.; Cordel, N.; Alexandre, M.; Roux–Villet, C. Le; Caux, F.

doi:10.1016/j.jaad.2021.10.034

Cited by 20 publications

(27 citation statements)

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“…However, most patients were able to mount an efficient immunological response to vaccine, while the highest rate of failed seroconversion was registered among patients under systemic corticosteroids or B-cell depleting therapies ( 24 ). In fact, rituximab and prednisone or prednisolone doses greater than 10 mg/die were also associated with higher risk of COVID-19 and hospitalization in patients with autoimmune or rheumatic diseases ( 25 , 26 ), thus underlining the fundamental role of humoral response against SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

et al. 2022

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BackgroundA few studies on vaccination in patients with rheumatic diseases, including arthritis, connective tissue diseases, vasculitis, and psoriatic arthropathy (PsA), demonstrated reduced production of neutralizing antibodies to SARS-CoV-2 Spike RBD (receptor-binding domain contained in the N-terminal of the S1 globular head region) when compared to the general population.ObjectiveThe aim of our study was to observe whether different therapies for PsA [methotrexate, anti-TNF antibodies, soluble TNF receptor (etanercept) or IL-17 inhibitors] have a different impact on SARS-CoV-2 vaccination in a homogeneous population of patients.MethodsWe enrolled 110 PsA patients in remission, assessed with Disease Activity in PSoriatic Arthritis (DAPSA). Of these: 63 were in treatment with anti-TNF-α therapy (26 etanercept, 15 certolizumab, 5 golimumab, 17 adalimumab); 37 with anti-IL17 secukinumab; 10 with methotrexate. All patients underwent vaccination for SARS-CoV-2 with mRNA BNT162b2 vaccine. Assessment of absolute and percentage lymphocyte subsets and anti-SARS-CoV-2 Spike RBD IgG antibody value 3 weeks after the second vaccine dose were performed. In addition, the serum antibody levels of 96 healthy healthcare workers (HCW) were analyzed.ResultsThe mean disease activity assessed with DAPSA score was 2.96 (SD = 0.60) with no significant differences between patients under different medications (p = 0.779). Median levels of neutralizing antibodies to SARS-CoV-2 Spike RBD were 928.00 binding antibody unit (BAU)/mL [IQR 329.25, 1632.0]; 1068.00 BAU/ml [IQR 475.00, 1632.00] in patients taking MTX, 846.00 BAU/ml [IQR 125.00, 1632.00] in patients taking etanercept, 908.00 BAU/mL [IQR 396.00, 1632.00] in patients taking anti-IL17 and 1148.00 BAU/ml [IQR 327.00, 1632.00] in patients taking TNF-α inhibitors, without statistically significant differences between these groups. Mean serum antibody level of HCW group was 1562.00 BAU/ml [IQR 975.00, 1632.00], being significantly higher than in the patient group (p = 0.000816). Absolute and percentage count of lymphocyte subsets were not statistically different between the subgroups under different treatments and when compared with HCW.ConclusionsAs for other rheumatic diseases on immunomodulatory treatment, our data showed a reduced humoral response in PsA patients compared to the control group. However, antibody response did not significantly differ between groups treated with different medications.

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Section: Discussionmentioning

confidence: 99%

Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

et al. 2022

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“…The percentage of patients with infectious pneumonia adverse events was higher than in other cohorts ( 11 , 28 ). The latter might have been increased by the COVID-19 pandemic that occurred in 2019; in this regard, a study in France previously reported that patients with AIBD receiving RTX had a 5-fold higher incidence of COVID-19 infection than patients who did not receive RTX during the first COVID-19 wave ( 45 ). Patients with AIBD with COVID-19 also demonstrated a 5.9-fold higher risk of dying ( 45 ), but no patient in this series had fatal issues.…”

Section: Discussionmentioning

confidence: 99%

“…The latter might have been increased by the COVID-19 pandemic that occurred in 2019; in this regard, a study in France previously reported that patients with AIBD receiving RTX had a 5-fold higher incidence of COVID-19 infection than patients who did not receive RTX during the first COVID-19 wave ( 45 ). Patients with AIBD with COVID-19 also demonstrated a 5.9-fold higher risk of dying ( 45 ), but no patient in this series had fatal issues. Finally, the incidences of infectious adverse events and pneumonia were lower than those reported in a study that explored their incidence according to age in a series of patients with auto-immune diseases receiving RTX ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

Rituximab Therapy for Mucous Membrane Pemphigoid: A Retrospective Monocentric Study With Long-Term Follow-Up in 109 Patients

et al. 2022

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Mucous membrane pemphigoid (MMP) is a heterogeneous group of rare, chronic, subepithelial autoimmune blistering diseases (AIBDs) with predominant involvement of mucous membranes that can be sight-threatening and life-threatening. Rituximab (RTX) has demonstrated its efficacy in severe MMP refractory to conventional immunosuppressants in small series that differed in RTX scheme, concomitant therapies, and outcome definitions. In a meta-analysis involving 112 patients with MMP treated with RTX, complete remission (CR) was reported in 70.5% of cases. Herein, we report the largest retrospective monocentric study on RTX efficacy in a series of 109 severe and/or refractory patients with MMP treated with RTX with a median follow-up period of 51.4 months. RTX was administered in association with immunomodulatory drugs (dapsone, salazopyrine) without any other systemic immunosuppressant in 104 patients. The RTX schedule comprised two injections (1 g, 2 weeks apart), repeated every 6 months until CR or failure, with a unique consolidation injection (1 g) after CR. The median survival times to disease control and to CR were 7.1 months and 12.2 months, respectively. The median number of RTX cycles required to achieve CR in 85.3% of patients was two. The larynx was the lesional site that took the longest time to achieve disease control. One year after RTX weaning, CR off RTX was obtained in 68.7% of cases. CR off RTX with only minimum doses of immunomodulatory drugs was achieved in 22.0% of patients. Further, 10.1% of patients were partial responders and 4.6% were non-responders to RTX. Relapse occurred in 38.7% of cases, of whom 91.7% had achieved CR again at the last follow-up. In MMP, CR was achieved in a longer time and after more rituximab cycles than in pemphigus, especially for patients with MMP with anti-type VII collagen reactivity. RTX with concomitant immunomodulatory drugs was not responsible for an unusual proportion of adverse events. This large study confirms that RTX is an effective therapy in patients with severe and/or refractory MMP, corroborating previous findings regarding the effects of RTX on AIBDs such as pemphigus.

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“…Prolonged B-cell depletion, B-cell–T-cell crosstalk, and neutropenia are considered the possible mechanisms of increased susceptibility of COVID-19 infection following Rituximab infusion [ 53 ]. In a recent study, Joly P and colleagues [ 54 ] reported a more than 5-fold higher risk of COVID-19 infection in patients with AIBD who received Rituximab compared with those who did not. Similarly, in the Swedish, Spelman et al [ 55 ] conducted research on 476 COVID-19 cases who had formerly developed multiple sclerosis, and found Rituximab in confirmed COVID-19 patients was associated with 2.95 times the odds of hospitalization relative to other combined therapies.…”

Section: Rituximab or Not For Pemphigus Patients?mentioning

confidence: 99%

Pemphigus during the COVID-19 Epidemic: Infection Risk, Vaccine Responses and Management Strategies

Huang

Liang

Zhang

et al. 2022

JCM

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Pemphigus is a rare autoimmune blistering disease, involving potentially life-threatening conditions often requiring immunosuppression. Currently, the COVID-19 pandemic caused by severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection has become a global public emergency. Vaccines are the most effective defense against COVID-19 infection. However, in clinic, there are cases of new onset or flare of pemphigus following COVID-19 vaccination, where vaccines have manifested significantly desirable risk-benefit profiles for patients. Although Rituximab, as first-line therapy, may impair humoral immunity, pemphigus may not predispose to develop COVID-19 infection compared to a healthy population. Conversely, delay or interruption of immunosuppressants probably results in unfavorable clinical outcomes for disease progression. Overall, clinicians should encourage their patients to undergo the vaccination after a comprehensive assessment. The definite association between COVID-19 vaccination and pemphigus remains to be further elucidated. Herein, we provide an overview of the published studies to date on COVID-19 and pemphigus as well as the exploration of their complicated interplay. In addition, we discuss the management strategies for pemphigus patients in this special period, in an effort to more effectively establish a standard treatment paradigm for this particular patient group.

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Incidence and severity of COVID-19 in patients with autoimmune blistering skin diseases: A nationwide study

Cited by 20 publications

References 5 publications

Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

Rituximab Therapy for Mucous Membrane Pemphigoid: A Retrospective Monocentric Study With Long-Term Follow-Up in 109 Patients

Pemphigus during the COVID-19 Epidemic: Infection Risk, Vaccine Responses and Management Strategies

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