TY - JOUR T1 - Response to: ‘Correspondence on Recovery from COVID-19 in a patient with spondyloarthritis treated with TNF-alpha inhibitor etanercept. A report on a COVID-19 patient with psoriatic arthritis receiving ustekinumab’ by Messina <em>et al</em> JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - e80 LP - e80 DO - 10.1136/annrheumdis-2020-218147 VL - 80 IS - 5 AU - Pierre-Marie Duret AU - Lionel Spielmann AU - Laurent Messer Y1 - 2021/05/01 UR - http://ard.bmj.com/content/80/5/e80.abstract N2 - We thank Messina et al for their interest in our article reporting a benign evolution of COVID-19 in a patient with spondyloarthritis (SPA) treated with a combination of disease-modifying antirheumatic drugs (DMARDs), methotrexate and a tumour necrosis factor (TNF)-alpha inhibitor, etanercept.1 2 We read with deep interest their report on a patient with psoriatic arthritis treated with ustekinumab, an antagonist of the interleukin (IL)-12/23 axis, who developed a moderate form of COVID-19, with full recovery.1 Of interest, a Th17 immune response with overexpression of IL-17, among other cytokines, has been shown elsewhere associated with COVID-19-related cytokine release syndrome (CRS).3–6 The authors are balancing an apparent paradox of an increased risk of infection, because of a potential compromised viral clearance, in patients exposed to ustekinumab, contrasting with a potential ‘protective’ effect of IL-12/23 inhibition, which might limit a deregulated Th1 and Th17 immune response leading to CRS associated with severe evolution of COVID-19.1 ,6 ,7 Presumably, this phenomenon might not be restricted to IL-12/23 inhibitors, but is likely to be extended for a broader panel of conventional, biological or targeted synthetic DMARDs, particularly anticytokine drugs, echoing our observation.2 In addition, recent registry data have shown lower hospitalisation rates in patients treated with TNF-alpha inhibitors.8 Conversely, concerns have recently been raised suggesting a detrimental effect, with an increased risk of severe evolution and mortality, in patients treated with B-cell depleting monoclonal antibodies, such as the anti-CD20 rituximab (RTX).9–11 Collectively, these emerging data, along with the experience of rheumatologists regarding the risk of infection in patients undergoing immunosuppressive therapies, support the current European League Against Rheumatism (EULAR) recommendations relative to the management of patients with … ER -