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Correspondence
Increased risk for severe COVID-19 in patients with inflammatory rheumatic diseases treated with rituximab
  1. Hendrik Schulze-Koops1,
  2. Klaus Krueger2,
  3. Inka Vallbracht3,
  4. Rebecca Hasseli4,
  5. Alla Skapenko5
  1. 1 Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilans University Munich, Munich, Germany
  2. 2 Praxiszentrum St. Bonifatius, Munich, Germany
  3. 3 Department of Rheumatology, Clinical Immunology and Osteology, München Klinik Bogenhausen, Munich, Germany
  4. 4 Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Giessen, Germany
  5. 5 Division of Rheumatology and Clinical Immunology, Deparmtent of Medicine IV, Ludwig Maximilians University Munich, Munich, Germany
  1. Correspondence to Professor Hendrik Schulze-Koops, Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig Maximilians University Munich, Munich, Germany; hendrik.schulze-koops{at}med.uni-muenchen.de

https://doi.org/10.1136/annrheumdis-2020-218075

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    It is currently unknown whether immunosuppressive and/or immunomodulating agents such as biological disease-modifying antirheumatic drugs (bDMARDs) affect the rate and the outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections of patients with inflammatory rheumatic diseases (IRDs). While several national authorities have defined patients under immunosuppressive therapy as at risk for severe COVID-19,1 accumulating data from individual cases and also from case series, such as a series from Italy published in the Annals of the Rheumatic Diseases by Monti et al 2 and a report about patients with immune-mediated inflammatory diseases from New York,3 suggest that baseline use of bDMARDs is not associated with worse COVID-19 outcome. Although the idea of a potentially protective effect of bDMRADs in COVID-19 is intriguing, we feel that extrapolation of these initial data is dangerous and potentially harmful. In particular, some caution may have to be applied when employing rituximab (RTX), a B-cell depleting bDMARD, in patients with immune-mediated disease. This notion may be illustrated by the following observations:

    We recently lost two patients with rheumatoid arthritis (RA) treated with RTX to lethal COVID-19. The first patient, a 71-year-old man with rheumatoid factor …

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    Footnotes

    • Contributors HS-K, KK and AS: Literature search, data analysis, data interpretation, writing. IV and RH: Data collection, 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, conduct, reporting or dissemination plans of this research.

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

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