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  • Treatment of patients with inflammatory rheumatic diseases with rituximab should be carefully considered during the SARS-CoV-2/COVID-19 pandemic. Response to: ‘Persistence of rT-PCR-SARS-CoV-2 infection and delayed serological response, as a possible eff…

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Treatment of patients with inflammatory rheumatic diseases with rituximab should be carefully considered during the SARS-CoV-2/COVID-19 pandemic. Response to: ‘Persistence of rT-PCR-SARS-CoV-2 infection and delayed serological response, as a possible effect of rituximab according to the hypothesis of Schulze-Koops et al’ by Benucci et al
  1. Hendrik Schulze-Koops1,
  2. Klaus Krueger2,
  3. Inka Vallbracht Vallbracht3,
  4. Rebecca Hasseli4,
  5. Alla Skapenko1
  1. 1 Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
  2. 2 Praxiszentrum St. Bonifatius Muenchen, Muenchen, Germany
  3. 3 Department of Rheumatology, Clinical Immunology and Osteology, Munich Clinic Bogenhausen, Munich, Germany
  4. 4 Department of Rheumatology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
  1. Correspondence to Professor Hendrik Schulze-Koops, Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen 80336, Germany; hendrik.schulze-koops{at}med.uni-muenchen.de

https://doi.org/10.1136/annrheumdis-2020-218686

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    We thank Dr Benucci et al for their comments1 on our report on fatalities of patients with inflammatory rheumatic diseases (IRDs) treated with rituximab (RTX) during the SARS-CoV-2/COVID-19 pandemic.2 The authors present a case of COVID-19 in a patient with myositis treated with RTX, who required assisted ventilation and eventually recovered after intensive care including invasive ventilation and medication with remdesivir, dexamethason and tocilizumab. While emphasising the potential of RTX to lead to severe courses of COVID-19, a particularly interesting aspect of the report is the complete absence of antibodies to SARS-CoV-2 even up to 4 weeks after discharge of the patient. The authors therefore conclude that RTX may be hazardous in the present pandemic as it may inhibit the humoral response to SARS-CoV-2 and contribute to secondary worsening of COVID-19.

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors HS-K, KK, IV, RH and AS: literature search, data analysis, data interpretation, writing.

    • 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 None declared.

    • 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.

    • Provenance and peer review Commissioned; internally peer reviewed.

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