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COVID-19 in a patient with systemic sclerosis treated with tocilizumab for SSc-ILD
  1. Carina Mihai,
  2. Rucsandra Dobrota,
  3. Maria Schröder,
  4. Alexandru Garaiman,
  5. Suzana Jordan,
  6. Mike Oliver Becker,
  7. Britta Maurer,
  8. Oliver Distler
  1. Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Oliver Distler, Department of Rheumatology, University Hospital Zurich, Zurich 8091, Switzerland; oliver.distler{at}

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During the current global outbreak of coronavirus disease 2019 (COVID-19), risk stratification of patients is of utmost importance. Currently, patients >65 years and those with pre-existing medical conditions such as cardiovascular disease, chronic respiratory disease or diabetes mellitus are considered at higher risk for severe disease.1 The Swiss Federal Office of Public Health, like similar authorities around the world, has additionally included patients on immunosuppressants in the high-risk group for developing severe COVID-19.2 However, at this moment we do not have enough evidence either to support or to reject this assumption.

We report the case of a 57-year-old woman with systemic sclerosis (SSc) who developed COVID-19. Comorbidities were insulin-dependent type 2 diabetes mellitus and WHO grade I obesity. The anti-topoisomerase I antibody-positive patient was diagnosed with SSc in 2017. SSc-associated interstitial lung disease (SSc-ILD), with cough and exertion dyspnoea, was the leading organ manifestation, associated with symmetrical, non-erosive polyarthritis, and elevated acute phase reactants. Treatment with the anti-interleukin (IL) 6 receptor blocker tocilizumab, with 8 mg/kg body weight every 4 weeks intravenously, was started, leading to a good control of both arthritis and SSc-ILD, with gradual improvement of musculoskeletal and respiratory symptoms, …

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  • Handling editor Josef S Smolen

  • Contributors All authors contributed to one or more of the following aspects of the manuscript: conception, acquisition of data, drafting and revising the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CM had congress support from Actelion and Roche, consultancy fees from Boehringer Ingelheim and Geneva Romfarm; RD had research support from Actelion and Pfizer; BM had grant/research support from AbbVie, Protagen, Novartis, and congress support from Pfizer, Roche, Actelion, and MSD, speakers honorary from Novartis. In addition, BM has a patent mir-29 for the treatment of systemic sclerosis registered (US8247389, EP2331143). OD had speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Novartis, Roche, Menarini, Mepha, MSD, iQone, Pfizer, consultancy fees from Abbvie, Actelion, Acceleron Pharma, Amgen, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi, UCB, Amgen, Lilly, Target BioScience, Pfizer, project scoring fees from Abbvie, interview fees from Catenion, travel support from Pfizer, research grants from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd, Mitsubishi Tanabe, patent issued mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143).

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.