Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia

Guilpain, Philippe; Bihan, Clément Le; Foulongne, Vincent; Taourel, Patrice; Pansu, Nathalie; Maria, A.; Jung, Boris; Larcher, Romaric; Klouche, Kada; Moing, Vincent Le

doi:10.1136/annrheumdis-2020-217549

Cited by 122 publications

(113 citation statements)

References 8 publications

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“…Their use is associated with IgM deficiency in a substantial number of patients, while their impact on IgG and IgA levels is more limited (Kridin and Ahmed, 2020). In line with our data, recent studies reported that anti-CD20 therapy could be associated with a higher susceptibility to contract SARS-CoV-2 and develop severe COVID-19 (Guilpain et al, 2020;Hughes et al, 2020;Safavi et al, 2020;Schulze-Koops et al, 2020;Sharmeen et al, 2020;Sormani et al, 2020). Whether this is associated to the preferential depletion of IgM-producing B cells by these treatments (Looney et al, 2008) remains to be shown.…”

Section: Discussionsupporting

confidence: 77%

Major role of IgM in the neutralizing activity of convalescent plasma against SARS-CoV-2

Gasser

Cloutier

Prévost

et al. 2020

Preprint

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Characterization of the humoral response to SARS-CoV-2, the etiological agent of Covid-19, is essential to help control the infection. In this regard, we and others recently reported that the neutralization activity of plasma from COVID-19 patients decreases rapidly during the first weeks after recovery. However, the specific role of each immunoglobulin isotype in the overall neutralizing capacity is still not well understood. In this study, we selected plasma from a cohort of Covid-19 convalescent patients and selectively depleted immunoglobulin A, M or G before testing the remaining neutralizing capacity of the depleted plasma. We found that depletion of immunoglobulin M was associated with the most substantial loss of virus neutralization, followed by immunoglobulin G. This observation may help design efficient antibody-based COVID-19 therapies and may also explain the increased susceptibility to SARS-CoV-2 of autoimmune patients receiving therapies that impair the production of IgM.

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Section: Discussionsupporting

confidence: 77%

Major role of IgM in the neutralizing activity of convalescent plasma against SARS-CoV-2

Gasser

Cloutier

Prévost

et al. 2020

Preprint

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“…Nevertheless, he only developed moderate symptoms and no severe complications such as coagulation disorders, stroke, or liver failure ( 8 , 9 ). Similarly, one report of a rheumatoid arthritis patient treated with rituximab showed a considerably slower progression to severe disease compared to other cohorts ( 10 ). Two large cohorts of cancer patients with COVID-19 have identified risk factors associated with death.…”

Section: Discussionmentioning

confidence: 83%

Prolonged Course of COVID-19-Associated Pneumonia in a B-Cell Depleted Patient After Rituximab

et al. 2020

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Patients with pre-existing comorbidities and immunosuppression are at greater risk for SARS-CoV-2 infection and severe manifestations of COVID-19. This also includes cancer patients, who are shown to have a poor prognosis after infection. Here, we describe the case of a 72-year old male patient with B-cell depletion after maintenance treatment with rituximab for non-Hodgkin-lymphoma who had a prolonged COVID-19 course and initial false negative test results. Our case highlights the diagnostic pitfalls in diagnosing COVID-19 in B-cell depleted patients and discuss the role of B-cell depletion in the course and treatment of COVID-19. Furthermore, we investigated peripheral blood monocytes and SARS-CoV-2 specific T cells in our patient. In conclusion, our case report can help physicians to avoid diagnostic pitfalls for COVID-19 in hemato-oncological patients under chemoimmunotherapy and tries to explain the role of B-cell depletion and SARS-CoV-2 specific T cells in this context.

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“…There is only one case of granulomatosis with polyangiitis who developed COVID-19 infection after a maintenance dose of rituximab. The patient recovered after a severe course of COVID-19 [12].…”

Section: Discussionmentioning

confidence: 92%

Anti-Neutrophilic Cytoplasmic Antibody (ANCA) Vasculitis Presented as Pulmonary Hemorrhage in a Positive COVID-19 Patient: A Case Report

Hussein

Khalil

Bawazir³

2020

Cureus

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Granulomatosis with polyangiitis is a small vessel vasculitis with a wide spectrum of presentation, ranging from limited disease to life-threatening situation such as alveolar hemorrhage. Immunosuppression is the corner stone of the treatment and if left untreated, the death toll increases dramatically. We presented a case of granulomatosis with polyangiitis, presented with alveolar hemorrhage associated with COVID-19 infection. The patient admitted to the intensive care unit, received pulse steroids, plasmapheresis and intravenous immunoglobulin. She was not given further immunosuppression because of the coexisting COVID-19. Up to our knowledge, this is the first reported case of alveolar hemorrhage secondary to granulomatosis with polyangiitis coexisting with COVID-19 infection.

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Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia

Cited by 122 publications

References 8 publications

Major role of IgM in the neutralizing activity of convalescent plasma against SARS-CoV-2

Major role of IgM in the neutralizing activity of convalescent plasma against SARS-CoV-2

Prolonged Course of COVID-19-Associated Pneumonia in a B-Cell Depleted Patient After Rituximab

Anti-Neutrophilic Cytoplasmic Antibody (ANCA) Vasculitis Presented as Pulmonary Hemorrhage in a Positive COVID-19 Patient: A Case Report

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