Persistent-relapsing SARS-CoV-2 infection following rituximab treatment for autoimmune rheumatic diseases: diagnosis and outcomes.

IF 4.7 2区医学 Q1 RHEUMATOLOGY

RMD Open Pub Date : 2025-07-21 DOI:10.1136/rmdopen-2025-005756

Katerina Chavatza, Elisavet Mastrostamati, Charalampos Charalampidis, Elvira-Markela Antonogiannaki, Ioannis Grigoropoulos, Emmanouil Karofylakis, Foteini Gkolemi, Georgios Koromvokis, Electra Kalara, Eleni Sambatakaki, Antonis Fanouriakis, Konstantinos Thomas

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Abstract

Background: COVID-19 may persist or relapse in patients on B-cell depleting biologic therapies.

Objective: To examine the rate and outcome of persistent-relapsing COVID-19 (prCOVID-19) in patients with autoimmune rheumatic diseases (AIRD) treated with rituximab (RTX).

Methods: Single-centre, retrospective cohort study of patients diagnosed with prCOVID-19 (June 2021 to January 2025). prCOVID-19 was defined as persistence of symptoms and lung imaging findings for >30 days, along with persistently positive or PCR-based conversion in upper or lower respiratory tract samples.

Results: 26 out of 225 (11.6%) AIRD patients, previously diagnosed with COVID-19 during RTX treatment period, developed 27 prCOVID-19 events (females: 20 (76.9%), median age: 61 years, median disease duration: 5.5 years, ≥3 COVID-19 vaccine doses: 20 (76.9%)). No prCOVID-19 infection in a control sample of 661 patients treated with other biologic/targeted synthetic/conventional synthetic disease-modifying antirheumatic drugs was documented. Median cumulative RTX dose was 12 g, while in 17 (68%) prCOVID-19 events, IgG levels were below 700 mg/L. Median duration of prCOVID-19 infection was 65 (IQR 74) days and median duration of hospitalisation 10.5 (IQR 14) days. 11 patients (42.3%) had ≥2 hospitalisations, 3 patients needed mechanical ventilation and 4 deaths were recorded. 59 of 113 (52.2%) nasopharyngeal PCR samples (NPS) and 12/17 (70.6%) bronchoalveolar lavage (BAL) PCR samples were positive during prCOVID-19. Bronchoscopy established the diagnosis of prCOVID-19 in 33% of events.

Conclusion: AIRD patients treated with RTX are at risk for prCOVID-19. In such patients, the diagnostic accuracy of NPS PCR is suboptimal, necessitating PCR testing in BAL when prCOVID-19 is highly suspected.

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利妥昔单抗治疗自身免疫性风湿病后持续复发的SARS-CoV-2感染：诊断和结果

背景：在b细胞消耗生物疗法的患者中，COVID-19可能持续存在或复发。目的：探讨利妥昔单抗（RTX）治疗自身免疫性风湿性疾病（AIRD）患者持续复发的COVID-19 （prCOVID-19）的发生率和转归。方法：对诊断为prCOVID-19的患者（2021年6月至2025年1月）进行单中心、回顾性队列研究。prCOVID-19被定义为症状和肺部影像学表现持续60 - 30天，同时上呼吸道或下呼吸道样本持续呈阳性或pcr转化。结果：225例AIRD患者中有26例（11.6%）在RTX治疗期间曾诊断为COVID-19，发生27例COVID-19前事件（女性：20例（76.9%），中位年龄：61岁，中位病程：5.5年，≥3次COVID-19疫苗剂量：20例（76.9%））。661例接受其他生物/靶向合成/常规合成疾病缓解抗风湿药物治疗的患者的对照样本中没有记录到covid -19病毒感染。RTX的中位累积剂量为12 g，而在17例（68%）预防covid -19事件中，IgG水平低于700 mg/L。前covid -19感染的中位持续时间为65 （IQR 74）天，中位住院时间为10.5 （IQR 14）天。11例（42.3%）住院≥2次，3例需要机械通气，4例死亡。113份鼻咽PCR （NPS）标本中59份（52.2%）和12/17份（70.6%）支气管肺泡灌洗（BAL） PCR阳性。支气管镜检查在33%的事件中确定了prCOVID-19的诊断。结论：RTX治疗的AIRD患者存在prCOVID-19的风险。在这类患者中，NPS PCR的诊断准确性不理想，当高度怀疑prCOVID-19时，需要在BAL中进行PCR检测。

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来源期刊

RMD Open RHEUMATOLOGY-

CiteScore

7.30

自引率

6.50%

发文量

205

审稿时长

14 weeks

期刊介绍： RMD Open publishes high quality peer-reviewed original research covering the full spectrum of musculoskeletal disorders, rheumatism and connective tissue diseases, including osteoporosis, spine and rehabilitation. Clinical and epidemiological research, basic and translational medicine, interesting clinical cases, and smaller studies that add to the literature are all considered.