Increased risk for severe COVID-19 in patients with inflammatory rheumatic diseases treated with rituximab

Schulze‐Koops, Hendrik; Krueger, Klaus; Vallbracht, Inka Vallbracht; Hasseli, Rebecca; Skapenko, Alla

doi:10.1136/annrheumdis-2020-218075

Cited by 128 publications

(115 citation statements)

References 4 publications

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“…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.…”

Section: Discussionsupporting

confidence: 78%

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

Gasser

Cloutier

Prévost

et al. 2020

Preprint

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Characterization of the humoral response to SARS-CoV-2, the etiological agent of Covid-19, is essential to help control the infection. In this regard, we and others recently reported that the neutralization activity of plasma from COVID-19 patients decreases rapidly during the first weeks after recovery. However, the specific role of each immunoglobulin isotype in the overall neutralizing capacity is still not well understood. In this study, we selected plasma from a cohort of Covid-19 convalescent patients and selectively depleted immunoglobulin A, M or G before testing the remaining neutralizing capacity of the depleted plasma. We found that depletion of immunoglobulin M was associated with the most substantial loss of virus neutralization, followed by immunoglobulin G. This observation may help design efficient antibody-based COVID-19 therapies and may also explain the increased susceptibility to SARS-CoV-2 of autoimmune patients receiving therapies that impair the production of IgM.

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Section: Discussionsupporting

confidence: 78%

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

Gasser

Cloutier

Prévost

et al. 2020

Preprint

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“…These 10 patients were from various case reports and case series. Of these 10 patients, 8 had bilateral pneumonia requiring hospitalization and supplementary oxygen and three died [9,[15][16][17][18][19][20]. All these reports suggest a possible association between rituximab treatment for RMDs and poor prognoses for SARS-CoV-2 infected patients, but no study to date has analyzed the risk of SARS-CoV-2 infection and prognosis of such patients.…”

Section: Discussionmentioning

confidence: 99%

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

et al. 2020

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The objective of this study is to describe the characteristics and outcomes of rheumatic and musculoskeletal disease (RMD) patients who were treated with rituximab and had suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this descriptive study, RMD patients who were treated with rituximab in the last 12 months at the Rheumatology Department of our hospital were screened for SARS-CoV-2 infection via telephone interview and a comprehensive review of clinical health records (01/02/2020-26/05/2020). Those with probable or confirmed SARS-CoV-2 infection were included. In total, 76 patients were screened. Of these, 13 (17.1%) had suspected or confirmed SARS-CoV-2 infection. With regard to these 13 patients, the median age at coronavirus disease (COVID-19) diagnosis was 68 years (range 28-76 years) and 8 (61.5%) were female. Five patients had rheumatoid arthritis, three had systemic vasculitis, two had Sjögren syndrome, and two had systemic lupus erythematosus. Additionally, seven patients (53.8%) had pulmonary involvement secondary to RMD. Eight patients (61.5%) developed severe disease leading to hospitalization, and seven developed bilateral pneumonia and respiratory insufficiency. Of the eight hospitalized patients, five (62.5%) fulfilled the acute respiratory distress syndrome criteria and three developed a critical disease and died. Our cohort had a high rate of severe disease requiring hospitalization (61.5%), with bilateral pneumonia and hyperinflammation leading to a high mortality rate (23.1%). Treatment with rituximab should be considered a possible risk factor for unfavorable outcomes in COVID-19 patients with RMD. However, further study is required to confirm this association.

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“…Data for other drugs are conflicting or incomplete and the rationale for their use is based on the immune system runaway and the secretion of pro-inflammatory cytokines in severe forms of the disease [ 21 ]. Even though several national authorities have defined patients under immunosuppressive therapy as at risk for severe COVID-19, it is currently unknown whether immunosuppressive and/or immunomodulating agents, such as biologics, affect the rate and the outcome of COVID-19 infections in RDs patients [ 22 ]. Thus, a call for careful consideration and close monitoring in the administration of biologics in RDs patients with COVID-19 is warranted [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient

et al. 2020

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During the coronavirus disease-2019 (COVID-19) pandemic there were several barriers to treatment access and medication adherence in rheumatoid arthritis (RA) patients. There is no information regarding the RA patient health status in Egypt during the COVID-19. Thus,the aim of this work was to study the impact of the pandemic on RA patients through a patient-reported questionnaire and to determine the influence of gender, geographic regions. This multi-centre study initiated by the Egyptian College of Rheumatology (ECR) was conducted on 1037 RA patients attending rheumatology clinics from 10 governorates. The questionnaire provided covered socio-demographic data, health/disease status, information/knowledge about COVID-19 and medical/family history of the infection. Patients mean age was 44.2 ± 12.3 years;855 females and 182 males; 539(52%) from rural and 497(48%) from urban areas. 41.8% reported a striking difficulty to obtain hydroxychloroquine during the pandemic. The majority (70%) considered maintaining a regular visit to the rheumatologist in addition to remote contact mainly by phone (44.4%) or via WhatsApp (33.1%), in particular among male and urban patients. Urban patients were more likely to be infected by COVID-19 (12.9% vs 6.2%; p < 0.0001) than rural. Northern cities had more patients with suspected COVID-19 (13.9% vs 6.1%; p < 0.0001); was significantly associated with more disease flares (30.8% vs 5.8%) with subsequent change in the RA treatment (20.9% vs 6.4%; p < 0.0001). Patients with RA faced remarkable difficulty to obtain their medications with subsequent change in their disease status. The challenges of the pandemic have hastened changes in the way we deliver health care. Electronic supplementary material The online version of this article (10.1007/s00296-020-04736-9) contains supplementary material, which is available to authorized users.

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Increased risk for severe COVID-19 in patients with inflammatory rheumatic diseases treated with rituximab

Cited by 128 publications

References 4 publications

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

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

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

Impact of COVID-19 pandemic on rheumatoid arthritis from a Multi-Centre patient-reported questionnaire survey: influence of gender, rural–urban gap and north–south gradient

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