B-cell targeted therapy is associated with severe COVID-19 among patients with inflammatory arthritides: a 1-year multicentre study in 1116 successive patients receiving intravenous biologics

Abstract

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Risk of severe COVID-19 outcomes associated with rheumatoid arthritis and phenotypic subgroups: a retrospective, comparative, multicentre cohort study

“…Among patients with rheumatoid arthritis-associated interstitial lung disease, a particularly high risk of severe COVID-19 might be the result of the parenchymal lung disease or exposure to medications (eg, rituximab or mycophenolate mofetil) often used to treat patients with rheumatoid arthritis and interstitial lung disease and known to be associated with poor COVID-19 outcomes. 2 , 24 , 25 , 26 Since patients in the comparator group were not on immunosuppressive medications, we were unable to examine the influence of baseline use of medications on COVID-19 severity. Rheumatoid arthritis disease activity might be a risk factor for rheumatoid arthritis-associated interstitial lung disease and bone erosions and for severe outcomes of COVID-19.…”

COVID-19 in people with rheumatic diseases: risks, outcomes, treatment considerations

“…Overall, the available data suggest that the use of many conventional synthetic DMARDs and bDMARDs does not confer increased risk of poor outcomes in COVID-19, which is consistent with the recommendations from the ACR and EULAR to continue current treatment with these agents in the absence of known exposure to SARS-CoV-2 in order to maintain good disease control 54,55 . However, there are some notable exceptions such as rituximab 56,57 , for which the risk of poor outcomes is becoming increasingly apparent. The issue of rituximab use is challenging, because the risk of poor outcomes from COVID-19 must be considered against the severity of the rheumatic disease that is being treated.…”

Cellular and humoral immunity after the third dose of SARS-CoV-2 vaccine in patients treated with rituximab

“…3 However, little is known to date regarding response to a third dose of vaccine in patients treated with rituximab, who are particularly prone to develop severe COVID-19. 4 In France, a systematic third dose of vaccine with mRNA-1273, BNT162b2, or ChAdOx1 nCoV-19 (Oxford-AstraZeneca) was recommended in highly immunocompromised patients (including patients treated with rituximab, mycophenolate mofetil, or cyclophosphamide) at least 1 month after the second dose, with no requirement for assessing serological response before the third dose. Given the uncertainties about the effectiveness of this measure in patients in whom B lymphocytes are not repopulated at the time of the third dose, we investigated the course of humoral and cellular immunity against SARS-CoV-2 in ten patients treated with rituximab after two and three vaccine doses.…”

“… 3 However, little is known to date regarding response to a third dose of vaccine in patients treated with rituximab, who are particularly prone to develop severe COVID-19. 4 …”