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We read with great interest the response from Snarskaya and Vasileva.1 A second wave of SARS-CoV-2 infection is now a global reality2: since the publication of the World Scleroderma Foundation preliminary advice on the management on systemic sclerosis (SSc) patients during the first COVID-19 pandemic,3 growing evidence has accumulated on COVID-19 affected SSc patients.4 Up to 22 June, at the end of the first wave, 25 cases of SSc-COVID-19 were published in the literature, most of them undergoing immunosuppressant treatment with corticosteroids (CCS), conventional synthetic disease modifying antirheumatic drugs (csDMARDs) (methotrexate or mycophenolate mofetil) or biological DMARD (bDMARDs) (rituximab or tocilizumab) and with a variable outcome.4 This heterogeneity was a limitation in understanding the possible influence of ongoing immunosuppression and the effect of administered treatments. A recent meta-analysis, including 62 studies with more than 300 000 patients with autoimmune diseases, concluded that bDMARD monotherapy was a protective factor for COVID-19-related hospitalisation and death, in particular with antitumour necrosis factor alpha, while the use of CCS, conventional-synthetic DMARDS (csDMARD) and csDMARDs/bDMARD combination exposed the patients to a higher risk.5 A focused analysis on SSc population has described more SSc-COVID-19 cases: 1/64 patients in Crisafulli et al,6 1/168 patients in Bellan et al 7 and 2/526 patients in Del Papa et al,8 with one of them, previously exposed …
Footnotes
Handling editor Josef S Smolen
Correction notice This article has been corrected since it published Online First. The provenance and peer review statement has been included.
Contributors CB and MM-C conceived, drafted and revised the manuscript.
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 MM-C reports grants and personal fees from Actelion, personal fees from Biogen, personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from CSL Behring, personal fees from Eli-Lilly, outside the submitted work. CB reports personal fees from Actelion, personal fees from Eli Lilly, grants from Gruppo Italiano Lotta alla Sclerodermia (GILS), grants from New Horizon Fellowship, grants from European Scleroderma Trials and Research (EUSTAR), grants from Foundation for Research in Rheumatology (FOREUM), grants from Fondazione Italiana per la Ricerca sull’Artrite (FIRA), outside the submitted work.
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 Commissioned; internally peer reviewed.