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We appreciated the comment from Cuceoglu et al 1 in response to our paper on the susceptibility and severity of COVID-19 in a population-based cohort of patients treated with biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).2 We did not observe patients with COVID-19 <45 years in our cohort of 1195 cases with autoimmune diseases treated with b/tsDMARDs in Reggio Emilia area. Confirming our results, the authors did not observe cases of COVID-19 in a series of 173 Turkish paediatric patients with rheumatological conditions treated with b/tsDMARDs interviewed by telephone. This study confirm also the results of an Italian series of 123 paediatric patients with chronic rheumatic diseases from a geographical area (Lombardia) at high diffusion of COVID-19.3 Therefore, adult and paediatric patients with autoimmune conditions treated with b/tsDMARDs did not seem to be at increased risk of COVID-19 compared with the general population, nor to have a worse prognosis when they contract it. However, it cannot be excluded, considering that asymptomatic or mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections seem to be frequent in paediatric patients,4 that some cases may escape clinical recognition. Even if some b/tsDMARDS have been proposed for their mechanism of action as possible treatment of the cytokine storm observed in COVID-19, this does not imply that the patients treated with these drugs are protected against SARS-CoV-2 infection. Therefore, also paediatric patients with rheumatological diseases should be strongly advised to comply all preventive and control measures prescribed by the health authorities,5 particularly hygiene precautions and social distancing. On the other hand, these data, which need to be confirmed by larger prospective studies, reassure on continuing b/tsDMARDs also in paediatric patients during SARS-CoV-2 epidemic. In particular, maintaining the disease activity under control protects the patient from superimposed infections.
Handling editor Josef S Smolen
Contributors All contributed.
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 Commissioned; internally peer reviewed.
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