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Correspondence
Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia
  1. Philippe Guilpain1,2,
  2. Clément Le Bihan3,
  3. Vincent Foulongne4,
  4. Patrice Taourel5,
  5. Nathalie Pansu3,
  6. Alexandre Thibault Jacques MARIA1,2,
  7. Boris Jung6,7,
  8. Romaric Larcher6,7,
  9. Kada Klouche6,7,
  10. Vincent Le Moing3
  1. 1 Internal Medicine: Multi-Organic Diseases, Local Referral Center for systemic autoimmune diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France
  2. 2 Univ Montpellier, IRMB, Univ Montpellier, INSERM, Montpellier, France
  3. 3 Tropical and Infectious Diseases, Saint Eloi Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier cedex 5, France
  4. 4 Pathogenesis and Control of Chronic Infections, Inserm, Universite Montpellier 1 Faculte de Medecine Montpellier-Nimes, Montpellier, Languedoc-Roussillon, France
  5. 5 Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
  6. 6 Department of Intensive Care Medicine, Lapeyronie Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier, France
  7. 7 Inserm, CNRS, PhyMedExp, Univ Montpellier, Montpellier, France
  1. Correspondence to Dr Alexandre Thibault Jacques MARIA, Internal Medicine: Multi-Organic Diseases, Local Referral Center for systemic autoimmune diseases, Montpellier University Hospital, Univ Montpellier, Medical School, Montpellier cedex 5, France; a-maria{at}chu-montpellier.fr.fr; Dr Philippe Guilpain, Internal Medicine: Multi-Organic Diseases, Local Referral Center for systemic autoimmune diseases, Montpellier University Hospital, Univ Montpellier, Medical School, Montpellier University Hospital, Montpellier, France; p-guilpain{at}chu-montpellier.fr

https://doi.org/10.1136/annrheumdis-2020-217549

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    In the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (covid-19),1 2 the preliminary experience reported by Monti S and colleagues3 suggests that patients with chronic arthritis (rheumatoid arthritis and spondyloarthritis) receiving bDMARDs (biologic disease-modifying anti-rheumatic drugs) or tsDMARDs (targeted synthetic DMARDs) may not exhibit an increased risk of severe covid-19. These data must be strengthened and confirmed at a larger scale, but remain positive in this drastic context. The authors rightly recommend a continuous surveillance of patients under immunosuppressants, especially since data are lacking in many systemic autoimmune/inflammatory diseases. Notably, anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a group of vasculitides that can involve the respiratory tract (upper and lower airways) and the recent outbreak of covid-19 raises many specific questions concerning the severity of viral infection in AAV patients as well as the therapy with rituximab. Indeed, rituximab, a monoclonal antibody targeting CD20, has become the cornerstone of treatment in the last decade, but is responsible for long-lasting B-cell depletion and potentially severe infectious events (IE) independently from covid-19.4 A recent observation from our centre illustrates some specific issues with this drug.

    A 52-year-old woman was followed for granulomatosis …

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    Footnotes

    • Contributors All authors have contributed to this manuscript and fulfil the requirements for authorship.

    • 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 PG has been a medical expert for LFB (Laboratoire Français du Biofractionnement) and has received fees from Abbvie, Actelion, Boehringer Ingelheim France, Bouchara-Recordati, Novartis, Pfizer and Roche in the last 5 years. ATJM has received fees from Abbvie, Actelion, CSL Behring, Experf, Novartis and Shire and declares speaking fees from Astra-Zeneca and BMS in the last 5 years.

    • 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.

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