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ACR 2020 | Daily Highlights
COVID-19 during Rituximab
COHORT OF RHEUMATIC PATIENTS TREATED WITH RITUXIMAB AND COVID-19: DOES RITUXIMAB TREATMENT INCREASES THE SEVERITY OF SARS-COV2 INFECTION?
Abstract: 0641
Authors: Antía García-Fernández et al.
INCIDENCE OF COVID-19 IN PATIENTS TREATED WITH INFLIXIMAB COMPARED TO PATIENTS TREATED WITH RITUXIMAB
Abstract: 0467
Authors: Cathy Melong Pianta et al.
Key content:
Both studies, one from Spain and one from Switzerland, have examined cohorts of patients treated with rituximab (RTX) for rheumatic musculoskeletal diseases (RMDs). In the Spanish cohort of RTX treated patients, 8 patients out of 76 were hospitalized for COVID-19, and 3 patients died. In the Swiss study, 4 patients out of 136 treated with RTX developed severe COVID-19 (death or intensive care hospitalisation), compared to none in the infliximab arm (102 patients). Comparing the anti-TNF arm with the RTX arm, the authors found that while the incidence of symptoms compatible with COVID-19 were similar, the incidence rate of severe COVI-19 was significantly higher on RTX (0,47 cases / 1000 patient days) compared to infliximab (0 case) (=0.04).
Relevance:
Most publications and guidelines have concluded that bDMARDs for RMDs are generally safe and do not increase the risk of COVID-19, nor the risk for severe evolution of COVID-19. However, several case reports have also warned against potential deleterious effects of long-lasting, cell-directed bDMARDs like RTX during the COVID-19 pandemic. Several cohorts have now reported a high rate of hospitalizations and death in patients treated with RTX, suggesting that a recent RTX treatment may indeed be a risk factor for severe SARS-Cov2 infection in patients with RMDs.
If clinically possible, it may be prudent to postpone or to replace RTX during the COVID-19 pandemic. Safer alternatives seem to be anti-TNF agents, anti-IL6 agents, JAK-inhibitors or abatacept.
Zusammenfassung und Kommentar von:
Prof. Dr. Axel Finckh
Genf
