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Response to: ‘COVID-19 in patients with rheumatological diseases treated with Anti-TNF’ by Brito et al and ‘Clinical characteristics and outcomes of patients with COVID-19 and rheumatic disease in China ‘hot spot’ versus in US ‘hot spot’: similarities and differences’ by Zhao et al
  1. Kristin M D’Silva1,
  2. Naomi Serling-Boyd1,
  3. Rachel Wallwork1,
  4. Tiffany Hsu2,
  5. Jeffrey A Sparks2,
  6. Zachary Scott Wallace1
  1. 1 Division of Rheumatology, Allergy, and Immunology, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Zachary Scott Wallace, Rheumatology Unit, Massachusetts General Hospital, Boston, MA 02114, USA; zswallace{at}

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We appreciate the comments by Brito et al,1 and Zhao et al,2 in response to our manuscript evaluating outcomes among a cohort of patients with rheumatic diseases and COVID-19.3 We were interested to read the reports of their patients during the COVID-19 pandemic and would like to reply to some of their queries.

Brito et al raised the important point that the risk of severe infections may vary with therapeutic class of immunosuppressive therapy. We agree that further studies are needed to assess this important question, and we plan to investigate this by therapeutic class for our cohort in future studies as our sample size grows. We agree that studies of therapeutic class will have to account for potential confounding factors, including glucocorticoid exposure, in their design. A recent report performed among patients with rheumatic diseases suggested lower odds of hospitalised infection for biological/targeted disease-modifying antirheumatic drugs (DMARDs) and higher odds …

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