Clinical course, severity and mortality in a cohort of patients with COVID-19 with rheumatic diseases

Nuño, Laura; Novella-Navarro, Marta; Bonilla, Gema; Franco-Gómez, Karen; Aguado, P.; Peiteado, Diana; Monjo, I.; Tornero, C.; Villalba, A.; Miranda-Carús, María-Eugenia; Miguel, Eugenio de; Bogas, P.; Castilla-Plaza, Ana; Bernad-Pineda, M.; García-Lorenzo, Elena; Rodríguez-Araya, Tamara; Balsa, Alejandro

doi:10.1136/annrheumdis-2020-218054

Cited by 74 publications

(87 citation statements)

References 8 publications

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“…Furthermore, the BIOBADASER cohort (from a multicenter Spanish registry assessing patients treated with biological or synthetic DMARDs) had two SARS-CoV-2-infected patients who were treated with rituximab, one of whom died (91 years old, hypertension, systemic vasculitis) [12]. Another study from Madrid, Spain recently reported that their entire cohort of seven RMD patients who were treated with rituximab developed SARS-CoV-2 infections requiring hospitalization, and one (14.2%) died due to respiratory failure [8]. We also found 10 COVID-19 patients with RMD who were treated with rituximab in the current literature.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are few data regarding specific risk factors for unfavorable outcomes, such as specific diseases or immunosuppressive drugs [ 5 ]. Further, some reports have suggested the worst prognosis for RMD patients who were treated with rituximab and developed SARS-CoV-2 infection [ 8 , 9 ]. Our objective was to describe the clinical characteristics and outcomes of our cohort of RMD patients who were treated with rituximab and had suspected or confirmed SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

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High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

et al. 2020

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The objective of this study is to describe the characteristics and outcomes of rheumatic and musculoskeletal disease (RMD) patients who were treated with rituximab and had suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this descriptive study, RMD patients who were treated with rituximab in the last 12 months at the Rheumatology Department of our hospital were screened for SARS-CoV-2 infection via telephone interview and a comprehensive review of clinical health records (01/02/2020-26/05/2020). Those with probable or confirmed SARS-CoV-2 infection were included. In total, 76 patients were screened. Of these, 13 (17.1%) had suspected or confirmed SARS-CoV-2 infection. With regard to these 13 patients, the median age at coronavirus disease (COVID-19) diagnosis was 68 years (range 28-76 years) and 8 (61.5%) were female. Five patients had rheumatoid arthritis, three had systemic vasculitis, two had Sjögren syndrome, and two had systemic lupus erythematosus. Additionally, seven patients (53.8%) had pulmonary involvement secondary to RMD. Eight patients (61.5%) developed severe disease leading to hospitalization, and seven developed bilateral pneumonia and respiratory insufficiency. Of the eight hospitalized patients, five (62.5%) fulfilled the acute respiratory distress syndrome criteria and three developed a critical disease and died. Our cohort had a high rate of severe disease requiring hospitalization (61.5%), with bilateral pneumonia and hyperinflammation leading to a high mortality rate (23.1%). Treatment with rituximab should be considered a possible risk factor for unfavorable outcomes in COVID-19 patients with RMD. However, further study is required to confirm this association.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

et al. 2020

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“…The series published in adults agree that patients with RD have a similar risk to the general population of contracting a SARS-CoV-2 infection and those having other comorbidities like hypertension, diabetes or cardiac diseases are at higher risk of developing a more severe course of COVID-19 [4][5][6][7]. However, certain conditions such as the presence of active disease, and some immunosuppressants confer an increased risk of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in adults with RD show that immune-mediated inflammatory disease and use of biologics are not associated with worse COVID-19 [4][5][6][7]. However, if patients have poorly controlled active RD or receive some treatments such as corticosteroids, they may have an increased risk of infection and serious disease .…”

Section: Introductionmentioning

confidence: 99%

COVID-19 in children with rheumatic diseases (RD) in the spanish national cohort EPICO-AEP

Calvo

Remesal

Murías

et al. 2020

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Objectives: SARS-CoV-2 infection in adults with rheumatic diseases (RD) is a cause for concern. Data in the pediatric population are practically absent. We aimed to describe the prevalence of patients with RD and their complications among children admitted with COVID-19 in the Spanish national cohort EPICO-AEP; a multicenter prospective national study. Methods: Children <18 years old with RD and COVID-19 enrolled in EPICO-AEP were included in this study. Results: By June 30th 2020, 350 children were admitted in secondary and tertiary hospitals of Spain with SARS-CoV-2 infection. A total of 8 patients presented RD (2.2% of those hospitalized). All were female. The median age was 12.1 years (IQR 8.3-14.5). The diagnosis related with COVID-19 were febrile syndrome and/or upper respiratory infection (4 cases) and pneumonia (4 cases). One of the 8 (12.5%) patients with a severe juvenile dermatomyositis (JDM) with interstitial lung disease died. Juvenile idiopathic arthritis (JIA) was the most frequent diagnosis in 3/8 (37.5%) patients. In 5/8 (62.5%) cases, the RD was not fully controlled, and all patients except one received corticosteroid treatment. Conclusions: Children with RD have accounted for 2.2% of hospitalized patients with COVID-19 in our series. The evolution has been moderately favorable, with one deceased. In case of active disease and use of corticosteroids patients should be managed with caution. Key words: COVID-19, children, rheumatic diseases, corticosteroids.

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“…1 In their recent letter, Nuño and coworkers describe a large cohort of 122 patients with rheumatic diseases. 2 Most interestingly, higher hospitalisation rates and more severe and life-threatening cases of COVID-19 have been described with the use of rituximab (RTX). [2][3][4] To the best of our knowledge, we here describe the first reported case with repeated false-negative tests and a delayed diagnosis of COVID-19 in a patient with granulomatosis with polyangiitis (GPA) under maintenance therapy with RTX and concomitant influenza pneumonia.…”

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confidence: 99%

Repeated false-negative tests delayed diagnosis of COVID-19 in a case with granulomatosis with polyangiitis under maintenance therapy with rituximab and concomitant influenza pneumonia

et al. 2020

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Contributors BT conceived the correspondence and wrote the first draft. SH and JF collected pathology specimens and performed histological analysis. JL contributed and interpreted radiology images. PK and MSW provided clinical data. All authors participated in the construction and editing of the manuscript. Compassionate use was approved by our local ethics committee at the University of Göttingen and informed consent for publication was obtained from the patient's family. 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 Next of kin consent obtained. Provenance and peer review Not commissioned; internally peer reviewed. This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Clinical course, severity and mortality in a cohort of patients with COVID-19 with rheumatic diseases

Cited by 74 publications

References 8 publications

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

COVID-19 in children with rheumatic diseases (RD) in the spanish national cohort EPICO-AEP

Repeated false-negative tests delayed diagnosis of COVID-19 in a case with granulomatosis with polyangiitis under maintenance therapy with rituximab and concomitant influenza pneumonia

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