Incidence, Clinical Presentation, Relapses and Outcome of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Patients Treated With Anti-CD20 Monoclonal Antibodies. (12th August 2021)

• Record Type: Journal Article
• Authors: Calderón-Parra, Jorge; Múñez-Rubio, Elena; Fernández-Cruz, Ana; García-Sánchez, María Cristina; Maderuelo-González, Esther; López-Dosil, Marcos; Calvo-Salvador, Marina; Baños-Pérez, Isolina; Valle-Falcones, Manuel; Ramos-Martínez, Antonio
• Is Part Of: Clinical infectious diseases. Volume 74:Number 10(2022)
• Page Start: 1786
• Page End: 1794
• Publication Date: 2021-08-12
• Subjects: rituximab -- anti-CD20 monoclonal antibodies -- COVID-19 -- SARS-CoV-2 infection -- COVID-19 relapse; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab700
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Our objective is to describe the presentation and complications, including relapses, of coronavirus disease 2019 (COVID-19) in patients under anti-CD20 treatments. In addition, to describe viral clearance and determine the safety of reintroducing anti-CD20 treatment. Methods: Retrospective cohort study of 422 patients under anti-CD20 treatment that was administered from 1 January 2019 to 31 December 2020. Results: Fifty-seven patients were diagnosed with COVID-19 (13.5%). Twenty-five patients (43.9%) required hospital admission. Five patients died (8.8%), and 10 developed severe COVID-19 and acute respiratory distress syndrome. Mortality rate was higher among patients infected during the first 3 months following the last dose of anti-CD20 (14.7% vs 0%, P = .046). The median time of persistence of positive reverse transcription polymerase chain reaction (RT-PCR) was 22 days (IQR 13–40). Nine out of 52 survivors (17.3%) presented relapses. All of them received the last dose of anti-CD20 less than 6 months before the COVID-19 episode. Clinical presentation was fever (n = 8; 88.9%), dyspnea (n = 7; 77.8%), cough (n = 7; 77.8%), worsening of previous infiltrates (n = 5; 55.6%) and new pulmonary infiltrates (n = 8; 88.9%). An increase in lymphocytes with CD4/CD8 ratio inversion was observed in all cases. Among the 25 patients who resumed anti-CD20 drug, 4 (16.0%) presented relapses vs 5/28 among those who did not (17.9%), ( P = .857). Conclusions: Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the 6 months after anti-CD20 administration had a worse outcome and a higher mortality rate. The duration of infectivity may be longer. Relapses of COVID-19 occurred in more than 15% and were associated with viral replication. Once the infection is resolved, it is safe to restart treatment with anti-CD20. Abstract : Retrospective cohort study of 422 patients under anti-CD20 treatment, suggesting this therapy was not associated with increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but with infection within 6 months post-treatment, had higher hospital admission, mortality and relapse rate, and longer infectivity of coronavirus disease 2019 (COVID-19).