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We read with great interest the Global Rheumatology Alliance report on COVID-19 on biologic or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA).1 The first important result of the registry database is that B-cell depletion, by compromising the primary antibody response, increases the severity of infected patients. Considering the critical role of B cells in the adaptive immune response, this sounds quite correct.2 Even the data on interleukin 6 and tumour necrosis factor (TNF) inhibitors appear quite understandable considering the systemic inflammation raised by SARS-CoV-2 infection, the results of the Randomised Embedded Multifactorial Adaptive Platform for Community-acquired Pneumonia (REMAP-CAP) trial in patients on National Institute of Allergy and Infectious Diseases ordinal scale (NIAID)-Ordinal Scale 6 and 73 and the demonstrated role of TNF–TNF receptor 1 in inducing lymphopenia and T-cell dysfunction in severe–critical disease.4 Importantly, the death rate in abatacept was found close to that in JAK inhibitors. …
Contributors EG: Substantial contribution to study concept, drafted the paper for its intellectual content and approved the version of the submitted article. GF: Conceptualized the study, drafted the paper and approved the final version.
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 Not commissioned; internally peer reviewed.