Infectious Disease

Autoimmune disease, rituximab, has been linked to a higher risk of severe COVID-19 pneumonia

March 30, 2021

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The researchers do not report any relevant financial information.

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Patients with inflammatory rheumatic diseases, particularly those with autoimmune diseases, and patients treated with rituximab may have a higher risk of severe COVID-19 pneumonia than the general population, according to data.

“Patients with inflammatory rheumatic disease (IRD) are at higher risk for general infection due to the presence of comorbidities, the underlying disease activity, and the use of targeted immunomodulatory therapies.” Javier Bachelor-Corral, MD, of the Hospital Universitario Ramón y Cajal in Madrid, Spain, and colleagues wrote in the Journal of Rheumatology.

Patients with inflammatory rheumatic diseases, particularly those with autoimmune diseases, and patients treated with rituximab may have a higher risk of severe COVID-19 pneumonia than the general population, according to data. Data derived from Bachiller-Corral J, et al. J Rheumatol. 2021; doi: 10.3899 / jrheum.200755.

“Immunosuppressive Targeted Therapies (ITT) (biologics and Janus kinase inhibitors) have been linked to higher levels of immunosuppression and increases in bacterial and viral infections,” they added. “It is not known whether patients diagnosed with IRD are at risk of developing severe COVID-19.”

To analyze patients with inflammatory rheumatic disease who are hospitalized with COVID-19 and assess the potential risk of severe COVID-19 based on the type of rheumatic disease and immunosuppressive therapy compared to patients without inflammatory rheumatic disease, Bachiller-Corral and colleagues conducted a retrospective observational study with a center in the Ramón y Cajal hospital. According to the researchers, the facility treats 492,745 adult patients over the age of 16, including 4,592 previously diagnosed with inflammatory rheumatic disease and 883 who are receiving biologics or JAK inhibitors.

The population includes patients diagnosed with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, Sjogren’s syndrome, vasculitis, myopathy, rheumatoid polymyalgia, and 12 other inflammatory rheumatic diseases.

For their study, Bachiller-Corral and colleagues compared the baseline traits and notable comorbidities of the 4,592 patients with inflammatory rheumatic diseases with 488,153 locals from the general population found in the last Spanish national health survey of 2017. In addition, all registries of adult patients with confirmed COVID-19 who were hospitalized in Ramón y Cajal between March 1, 2020 and April 30, 2020 were included in the analysis. A total of 2,315 patients were enrolled for severe COVID-19 pneumonia.

According to the researchers, 1.8% of patients admitted for severe COVID-19 pneumonia also had inflammatory rheumatic disease. The operating room for hospitalization for patients with inflammatory rheumatic disease was 1.91 (95% CI, 1.41-2.61) compared to patients without inflammatory rheumatic disease. The ORs for inclusion were in patients with Sjogren’s syndrome (4.9; 95% CI, 1.86-12.94), vasculitis (3.9; 95% CI, 1.27-11.99), and SLE (3.38; 95% CI, 1.28-8.95) highest.

A total of 10 hospital patients with inflammatory rheumatic disease died.

Among the patients with inflammatory rheumatic disease, 27 received corticosteroids, 23 were treated with conventional DMARDs, 12 with biologics – including seven with rituximab (Rituxan; Genentech, Biogen), four with anti-TNF therapy and one with abatacept (Orencia, Bristol) Myers Squibb) – and one patient received JAK inhibitors. Rituximab was associated with the highest approval rate with 12.8 (95% CI, 5.82-28.51), while TNF inhibitors with 0.88 (95% CI, 0.31-2.5) compared to patients who received no biologics or JAK inhibitors were the lowest.

“Patients with IRD may be at greater risk for ingestion of COVID-19 than the reference population,” wrote Bachiller-Corral and colleagues. “This risk seems to be particularly high for people with systemic autoimmune diseases like SLE. [Sjögren’s syndrome] and [vasculitis]and patients undergoing treatment with rituximab. Conversely, treatment with anti-TNF was not associated with a higher rate of severe SARS-CoV-2 disease. “

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COVID-19 and rheumatology

COVID-19 and rheumatology

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