High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab:
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Rheumatology International https://doi.org/10.1007/s00296-020-04699-x
INTERNATIONAL
OBSERVATIONAL RESEARCH
High rates of severe disease and death due to SARS‑CoV‑2 infection in rheumatic disease patients treated with rituximab: a descriptive study Jesús Loarce‑Martos1 · Antía García‑Fernández1 · Fernando López‑Gutiérrez1 · Verónica García‑García1 · Laura Calvo‑Sanz1 · Iván del Bosque‑Granero1 · M. Andreína Terán‑Tinedo1 · Alina Boteanu1 · Javier Bachiller‑Corral1 · Mónica Vázquez‑Díaz1 Received: 22 July 2020 / Accepted: 31 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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. Keywords Rheumatic diseases · Rituximab · SARS-CoV-2 · COVID-19
Introduction Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection was first reported in Wuhan, China, in December 2019. The spread of SARS-CoV-2 infection was declared a pandemic in March 2020 by the World Health Organization with 800,906 deaths among 2,057,288 Jesús Loarce-Martos and Antía García-Fernández have equal contribution. * Jesús Loarce‑Martos [email protected] 1
Rheumatology Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo, 9, 1 km, 28043 Madrid, Spain
confirmed cases, which accounted for 3.89% of mortality among infected individuals [1]. Madrid, Sp
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