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We read with great interest the article by Salvarani et al comparing the COVID-19 infection susceptibility and severity between the patients treated with biologic or targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs) and all residents in the Reggio Emilia area.1 In their cohort of 1195 patients treated with b/tsDMARDs, there were nine confirmed COVID-19 cases. None of these COVID-19 cases were ≤45 years of age while only two out of 25 patients who were tested for COVID-19 were ≤45 years. They did not observe a different susceptibility or severity of COVID-19 in patients treated with these drugs.1
Biologic/targeted synthetic DMARDs often target pathways of the immune system and this may result in a tendency for infections.2 Serious infections have been reported in both children and adults treated with these drugs.3 However, the data about infection rate and severity in children on b/ts DMARDs are limited. Consistent with the findings of Salvarani et al, Gianfrancesco et al reported that the use of biologic DMARDs was not associated with a higher hospitalisation rate in the largest cohort of COVID-19 patients with rheumatic diseases (n=600).4 However, none of the patients were below the age of 18 years in their cohort. In the same lines, the results of the study by Sanchez-Piedra et al suggested that COVID-19 course and mortality did not differ significantly between adult rheumatology patients treated with b/tsDMARDs and the general population.5 To date, there is no report of a confirmed COVID-19 case among children with rheumatic diseases who are on biologic DMARDs. Thus, the COVID-19 infection rate and severity is currently unknown in paediatric rheumatology patients treated with b/tsDMARDs.
We performed a cross-sectional survey study to analyse the frequency/severity of COVID-19 in paediatric patients with rheumatic diseases, treated with b/tsDMARDs. Out of 189 paediatric rheumatology patients treated with b/ts DMARDs followed up in the Pediatric Rheumatology Unit of Hacettepe University, Ankara, Turkey, we reached 173 patients by telephone. The characteristics of these patients are presented in table 1. Thirty-one patients experienced symptoms associated with upper respiratory tract infection and 14 of these were tested for COVID-19. The results were negative in all. Three out of these 14 patients were admitted to the hospital and received intravenous antibiotic treatment. However, all were discharged within a few days without any further complications. Thus, in our cohort, the paediatric rheumatology patients treated with b/tsDMARDs did not seem to be at increased risk for COVID-19 disease or associated severe complications.
In the COVID-19 pandemic, the children are generally affected less than adults. Although the data about the COVID-19 infection rate and severity in adult patients treated with b/tsDMARDs increase with time, there is still no data regarding COVID-19 in children treated with these drugs. Filocamo et al also reported no confirmed COVID-19 case among their cohort of 123 paediatric rheumatology patients treated with bDMARDs.6 Current rheumatology guidelines recommend to continue all therapies that are used in disease control during the pandemic. Furthermore, we know that active disease is an independent risk factor for infections. Thus, it would be critical to follow the accumulating evidence and continue the b/tsDMARD therapies in both adults and children during the pandemic in the absence of COVID-19 to provide an effective disease control.
We would like to thank Nurse Melis Deveci Tertemiz for her helps while applying the survey.
Contributors All authors were involved in drafting and revising the manuscript, and approved the final version. Study design: EDB, YB and SO. Data collection: MKC and EDB. Interpretation and analysis of the data: MKC, EDB and YB. Interpretation and analysis of the data: EDB, MKC, YB and SO. MKC and EDB contributed equally to this study.
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.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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