Use of rituximab and the risk of adverse clinical outcomes in COVID-19 patients with systemic rheumatic disease
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Rheumatology INTERNATIONAL
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Use of rituximab and the risk of adverse clinical outcomes in COVID‑19 patients with systemic rheumatic disease Chia Siang Kow1 · Syed Shahzad Hasan2,3 Received: 22 September 2020 / Accepted: 26 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
We read with interest the descriptive study by LoarceMartos et al. [1] to investigate the clinical characteristics and outcomes of patients with systemic rheumatic disease receiving rituximab who acquired coronavirus disease 2019 (COVID-19) or were presumed to acquire COVID-19 in a Spanish hospital. It was reported in the study that patients with systemic rheumatic disease receiving rituximab had unfavorable prognosis upon hospitalization with COVID19, of which all experienced clinical worsening upon hospitalization and three out of eight hospitalized patients succumbed to death. In fact, the mortality rate among patients with systemic rheumatic disease receiving rituximab upon hospitalization with COVID-19 (37.5%) was higher than that reported in a retrospective observational, multicenter study [2] of 4035 Spanish hospitalized patients with COVID-19 (28.0%). Nevertheless, such finding was in contrast to a singlecenter case–control study [3] from the Lombardy region of Italy, involving 1193 patients with psoriasis receiving either biologic agents or conventional small molecule drugs. A comparison of the cohort of psoriasis patients with the general population in the region did not detect an increased risk of admission to an intensive care unit or of death among patients receiving biological agents. Adding to the evidence is that an observational cohort study [4] which evaluated the effect of biological disease-modifying antirheumatic drugs on the clincical outcomes of patients with rheumatoid arthritis who developed serious infections (non-COVID-19) and reported that both subgroup of patients who received tumor * Chia Siang Kow [email protected] 1
School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
2
Department of Pharmacy, University of Huddersfield, Huddersfield, UK
3
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
necrosis factor-alpha inhibitors and subgroup of patients who received biological agents other than tumor necrosis factor-alpha inhibitors had reduced odds for development of sepsis and reduced odds of mortality. Although the study by Loarce-Martos et al. [1] was limited by its small sample size, it does however indicate a possibility for differential risk of adverse clinical outcomes among patients with systemic rheumatic disease based on the type of biological agents received. Particularly, rituximab causes B cell depletion that can be associated with decreased antibody production. This is best demonstrated in a pooled analysis of 2578 patients who received rituximab (along with methotrexate) in clinical trials for rheumatoid arthritis where the proportion of patients with low immunoglobul
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