Considerations for Pharmacologic Management of Rheumatoid Arthritis in the COVID-19 Era: a Narrative Review.

IF 5.7 2区医学 Q1 RHEUMATOLOGY

Current Rheumatology Reports Pub Date : 2023-11-01 Epub Date: 2023-08-19 DOI:10.1007/s11926-023-01111-y

Rathnam Venkat, Zachary S Wallace, Jeffrey A Sparks

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引用次数: 1

Abstract

Purpose of review: To review the impact of disease-modifying antirheumatic drugs (DMARDs) on COVID-19 severity and vaccine immunogenicity and to discuss COVID-19 outcomes in patients with rheumatoid arthritis (RA).

Recent findings: Rituximab is associated with severe COVID-19 and impaired vaccine immunogenicity via its B cell-depleting mechanism. JAK inhibitors and glucocorticoids have been modestly associated with severe COVID-19 and impaired vaccine immunogenicity. TNF inhibitors may have a protective effect against severe COVID-19 and do not appear to affect vaccine immunogenicity. Clinical trials have shown improved seroconversion and antibody titers when methotrexate is held around vaccine doses, but this may yield increased risk of RA flare. Patients with RA are also impacted by DMARD disruption, RA flares, and post-acute sequelae of COVID-19 after COVID-19 infection. Given the risks of COVID-19, rituximab should be used with caution in RA. Holding methotrexate doses around COVID-19 vaccination improves immunogenicity but may increase RA flare risk.

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新冠肺炎时代类风湿性关节炎药物治疗的考虑因素：叙述性综述。

综述目的：综述疾病修饰抗类风湿药物（DMARDs）对新冠肺炎严重程度和疫苗免疫原性的影响，并讨论类风湿性关节炎（RA）患者的新冠肺炎结果。最近的研究结果：利妥昔单抗通过其B细胞消耗机制与严重的新冠肺炎和受损的疫苗免疫原原性相关。JAK抑制剂和糖皮质激素与严重的新冠肺炎和疫苗免疫原性受损适度相关。TNF抑制剂可能对严重的新冠肺炎具有保护作用，并且似乎不会影响疫苗免疫原性。临床试验表明，当甲氨蝶呤保持在疫苗剂量左右时，血清转化率和抗体滴度有所提高，但这可能会增加RA发作的风险。RA患者还受到DMARD破坏、RA发作和新冠肺炎感染后COVID-19]急性后遗症的影响。考虑到新冠肺炎的风险，利妥昔单抗在RA中应谨慎使用。在新冠肺炎疫苗接种前后保持甲氨蝶呤剂量可提高免疫原性，但可能增加RA发作风险。

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来源期刊

Current Rheumatology Reports RHEUMATOLOGY-

CiteScore

11.20

自引率

0.00%

发文量

期刊介绍： This journal aims to review the most important, recently published research in the field of rheumatology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of rheumatologic conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas such as the many forms of arthritis, osteoporosis and metabolic bone disease, and systemic lupus erythematosus. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also occasionally provided.