Correspondence on 'Second COVID-19 infection in a patient with granulomatosis with polyangiitis on rituximab'.
TL;DR: In this article, the authors reported a patient with granulomatosis with polyangiitis (GPA) being treated with rituximab (RTX), recurrent SARS-CoV-2 disease 2019 (COVID-19) and no detectable SARS CoV2 seroresponse after recovery.
Abstract: We read with great interest the recent article by Fiedman and Winthrop reporting a patient with granulomatosis with polyangiitis (GPA) being treated with rituximab (RTX), recurrent SARS-CoV-2 disease 2019 (COVID-19) and no detectable SARS-CoV-2 seroresponse after recovery.1 Anti-CD20 therapy impairs humoral response, theoretically increasing the risk of prolonged SARS-CoV-2 infection and shedding as well as subsequent reinfection.1–3 We have recently reported a patient with GPA under maintenance therapy with RTX and SARS-CoV-2 infection.4 Here, we report further details on anti-CD20 therapy with RTX, serological response to SARS-CoV-2 infection, virus elimination and corresponding B cell numbers. This case highlights that B cell numbers in patients with rheumatic diseases treated with RTX could associate with serological response to SARS-CoV-2 infection, which is particularly relevant as RTX may also impair the immunogenicity of SARS-CoV-2 vaccines.
An 80-year-old man had received a diagnosis of GPA in 2014 with biopsy-confirmed renal vasculitis and no history of pulmonary manifestation. After remission induction therapy, he received RTX at a dose of 500 mg every 6 months as maintenance therapy. The last …
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05 Sep 2021
TL;DR: According to the recommendations of the Association of Rheumatologists of Russia, a more rigorous assessment of indications for induction and maintenance therapy of RTX therapy and harmonization of the timing of drug administration and vaccination is required.
Abstract: In patients with immune-mеdiated (autoimmune) rheumatic diseases (IMIRD), there are a number of factors (advanced age, uncontrolled inflammation, initially irreversible damage to internal organs, comorbid pathology, genetic and other factors) that can potentially lead to an increase in “sensitivity” to SARS-CoV -2 (severe acute respiratory syndrome coronavirus-2) and concomitant viral and bacterial infections, an increase in the risk of a severe course of COVID-19 (coronavirus disease 2019), a decrease in the effectiveness of therapy for both IMIRDs and COVID-19. An important area of pharmacotherapy for IMIRDs and other autoimmune diseases is associated with the use of anti-B-cell drugs, primarily rituximab (RTX), which is a chimeric (mouse/human) monoclonal antibody (mAb) to the CD20 antigen of B cells. At present, in Russia, the RTM biosimilar, acellbia (BIOCAD), is widely used, which is not inferior to RTX in terms of efficiency and safety. The problems of anti-B-cell therapy during the COVID-19 pandemic in relation to the risk of infection, severe course and insufficient effectiveness of vaccination against SARSCoV- 2 are considered. According to the recommendations of the Association of Rheumatologists of Russia, a more rigorous assessment of indications for induction and maintenance therapy of RTX therapy and harmonization of the timing of drug administration and vaccination is required.
8 citations
TL;DR: In this paper, a patient with granulomatosis with polyangiitis on rituximab who developed a serological response to SARS-CoV-2 and attenuated viral spread only after B cell reconstitution was reported.
Abstract: We read with great interest the report by Tampe et al regarding their patient with granulomatosis with polyangiitis on rituximab who developed a serological response to SARS-CoV-2 and attenuated viral spread only after B cell reconstitution.1 This is an important observation, which is logical and further supports the recommendations to time the SARS-CoV-2 vaccine towards the end of the rituximab cycle and, if possible, to delay rituximab until 2–4 weeks after the second SARS-CoV-2 vaccination.2 3 While we agree with the …
5 citations
TL;DR: Bowman’s capsule rupture is an important renal pathological lesion, which correlates with severe clinical manifestations, pathological changes, and poor prognosis in patients with lupus nephritis, and for patients with existing crescents, Bowman's capsule rupture increased the cumulative risk of end-stage renal disease.
2 citations
References
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TL;DR: An immunocompromised patient who had persistent infection with SARS-CoV-2 over a period of months, despite several courses of treatment, is described.
Abstract: SARS-CoV-2 in an Immunocompromised Host This letter describes an immunocompromised patient who had persistent infection with SARS-CoV-2 over a period of months, despite several courses of remdesivi...
949 citations
TL;DR: An enzyme-linked immunosorbent assay (ELISA) for the detection of severe acute respiratory syndrome (SARS) coronavirus (CoV) nucleocapsid protein may serve as an alternative tool for the early diagnosis of Sars CoV infection in laboratories with limited resources and expertise and for mass screening for the reservoir of SARS CoV.
Abstract: We report the development of an enzyme-linked immunosorbent assay (ELISA) for the detection of severe acute respiratory syndrome (SARS) coronavirus (CoV) nucleocapsid protein. The assay was carried out with hyperimmune polyclonal nucleocapsid-specific antibodies from guinea pigs and rabbits immunized with recombinant His6-tagged SARS CoV nucleocapsid protein. The assay was used for the detection of SARS CoV nucleocapsid protein in nasopharyngeal aspirate, urine, and fecal samples collected from patients with confirmed SARS between days 2 and 33 after the onset of illness. The ELISA was capable of detecting this protein in SARS CoV cell culture lysates at 15 50% tissue culture infective doses/ml but did not produce positive signals when tested with cell culture lysates of human coronaviruses OC43 and 229E. When tested with 120 nasopharyngeal aspirate, 100 urine, and 100 fecal specimens from hospitalized patients without SARS, the assay was shown to have high specificities—96.7, 99, and 96%, respectively. In an evaluation of clinical specimens from SARS patients, 34 (52%) of 66 nasopharyngeal aspirate samples from 50 patients, 5 (5%) of 94 urine samples from 94 patients, and 36 (55%) of 65 fecal samples from 65 patients tested positive for SARS CoV nucleocapsid protein. Nucleocapsid protein could be detected from days 6 to 24 in nasopharyngeal aspirate specimens, from days 11 to 31 in urine specimens, and from days 8 to 32 in fecal specimens after the onset of illness. Moreover, the protein could be detected in 25 (83%) of 30 nasopharyngeal aspirate specimens obtained from days 11 to 15 and in all 7 fecal specimens obtained from days 21 to 32. Since the present ELISA is more convenient and economical than reverse transcription-PCR, it may serve as an alternative tool for the early diagnosis of SARS CoV infection in laboratories with limited resources and expertise and for mass screening for the reservoir of SARS CoV. Further studies on serial clinical specimens should reveal the duration of nucleocapsid protein shedding and may reveal a higher detection rate in SARS patients.
115 citations
TL;DR: Accumulating data suggest that baseline use of bDMARDs is not associated with worse COVID-19 outcome and that some caution may have to be applied when employing rituximab (RTX), a B-cell depleting b DMARD, in patients with immune-mediated disease.
Abstract: It is currently unknown whether immunosuppressive and/or immunomodulating agents such as biological disease-modifying antirheumatic drugs (bDMARDs) affect the rate and the outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections of patients with inflammatory rheumatic diseases (IRDs) While several national authorities have defined patients under immunosuppressive therapy as at risk for severe COVID-19,1 accumulating data from individual cases and also from case series, such as a series from Italy published in the Annals of the Rheumatic Diseases by Monti et al 2 and a report about patients with immune-mediated inflammatory diseases from New York,3 suggest that baseline use of bDMARDs is not associated with worse COVID-19 outcome Although the idea of a potentially protective effect of bDMRADs in COVID-19 is intriguing, we feel that extrapolation of these initial data is dangerous and potentially harmful In particular, some caution may have to be applied when employing rituximab (RTX), a B-cell depleting bDMARD, in patients with immune-mediated disease This notion may be illustrated by the following observations:
We recently lost two patients with rheumatoid arthritis (RA) treated with RTX to lethal COVID-19 The first patient, a 71-year-old man with rheumatoid factor positive, …
110 citations
TL;DR: "This work reviews the available data regarding the impact of rheumatoid arthritis therapy on the immunogenicity of various common vaccines, and also reviews rheumatic arthritis-specific vaccination recommendations, live vaccine safety concerns, and current gaps in understanding of these issues.
Abstract: Patients with rheumatoid arthritis are highly vulnerable to infections because of abnormalities in their immune system, and because of immunosuppressive effects of their medications. Vaccinations in this population are complicated by disease-modifying antirheumatic drugs, which also modulate or suppress the immune system and potentially decrease the immunogenicity and efficacy of the vaccines. We review the available data regarding the impact of rheumatoid arthritis therapy on the immunogenicity of various common vaccines. We also review rheumatoid arthritis-specific vaccination recommendations, live vaccine safety concerns, and current gaps in our understanding of these issues."
53 citations
TL;DR: In this article, the authors report a patient with granulomatosis with polyangiitis (GPA) being treated with rituximab who appears to have developed recurrent SARS-CoV-2 infections in the setting of high-risk employment and on recovery ultimately had no detectable SARS CoV2 IgG antibodies.
Abstract: Observational data suggest there may be an association between rituximab and severe COVID-19 outcomes.1–3 Anti-CD20 therapies impair humoral response, theoretically increasing the risk of prolonged SARS-CoV-2 infection and shedding, as well as subsequent reinfection. Here, we report a patient with granulomatosis with polyangiitis (GPA) being treated with rituximab who appears to have developed recurrent SARS-CoV-2 infections in the setting of high-risk employment and on recovery ultimately had no detectable SARS-CoV-2 IgG antibodies. This case highlights a potential risk of rituximab in patients with rheumatic disease, which will become especially relevant as rituximab may impair the immunogenicity of SARS-CoV-2 vaccines.
A woman in her 30s with a history of limited GPA on rituximab developed COVID-19 twice (figure 1). GPA manifestations have included erosive sinusitis, otitis, saddle nose deformity and orbital pseudotumour. She started rituximab in February 2019. The most recent dose of rituximab 1000 mg was given on 28 September 2020. On 14 August, a disease flare was treated with a 3-week prednisone taper, which completed approximately 4 weeks before COVID-19 infection. She works in an assisted living facility with ongoing staff and resident COVID-19 …
14 citations