ABSTRACT
INTRODUCTION: Over the last two decades, rituximab has become an increasingly popular drug in the treatment of a wide range of rheumatic diseases. However, with the advent of the COVID-19 pandemic, clinicians face challenges in weighing risk against benefit in its use. AREAS COVERED: A review of existing data was performed to examine the relationship between rituximab use, morbidity and mortality from COVID-19, and vaccine efficacy in patients with rheumatic diseases, aiming to guide clinicians in continued use of the medication and consider the direction of future research. A literature review was performed through a search of the PubMed database, using the terms ((SARS-CoV-2) OR (COVID-19)) AND (rituximab) AND (rheumatic), which generated an initial 55 results, with relevant articles then selected for inclusion. EXPERT OPINION: In order to safeguard patients with an ongoing need for rituximab therapy, vaccination remains the primary concern. A target of performing booster doses 6 months after last rituximab dose is a reasonable estimate, which may be made more precise by use of B cell counts, although primary immunization should not be delayed. In those patients who remain seronegative, the use of newer antivirals and broadly neutralizing antibody infusions may help provide further safeguards.
Subject(s)
COVID-19 Drug Treatment , Rheumatic Diseases , Humans , Rituximab , SARS-CoV-2 , Pandemics , Rheumatic Diseases/drug therapy , Rheumatic Diseases/chemically induced , VaccinationABSTRACT
SARS-CoV-2 has resulted in a global pandemic and an unprecedented public health crisis. Recent literature suggests the emergence of a novel syndrome known as 'long COVID', a term used to describe a diverse set of symptoms that persist after a minimum of 4 weeks from the onset of a diagnosed COVID-19 infection. Common symptoms include persistent breathlessness, fatigue and cough. Other symptoms reported include chest pain, palpitations, neurological and cognitive deficits, rashes, and gastrointestinal dysfunction. We present a complex case of a previously well 28-year-old woman who was diagnosed with COVID-19. After resolution of her acute symptoms, she continued to experience retrosternal discomfort, shortness of breath, poor memory and severe myalgia. Investigations yielded no significant findings. Given no alternative diagnosis, she was diagnosed with 'long COVID'.
Subject(s)
COVID-19/complications , Adult , COVID-19/diagnosis , Cough/virology , Dyspnea/virology , Fatigue/virology , Female , Humans , Memory Disorders/virology , Myalgia/virology , Post-Acute COVID-19 SyndromeABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread and have grave health and socioeconomic consequences worldwide. Researchers have raced to understand the pathophysiological mechanisms underpinning the disease caused by SARS-CoV-2 so that effective therapeutic targets can be discovered. This review summarises the key pharmacotherapies that are being investigated for treatment of COVID-19, including antiviral, immunomodulator and anticoagulation strategies.
Subject(s)
Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , COVID-19 Drug Treatment , Glucocorticoids/therapeutic use , Immunologic Factors/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Azetidines/therapeutic use , COVID-19/therapy , Colchicine/therapeutic use , Dexamethasone/therapeutic use , Humans , Immunization, Passive , Ivermectin/therapeutic use , Janus Kinase Inhibitors/therapeutic use , Purines/therapeutic use , Pyrazoles/therapeutic use , SARS-CoV-2 , Sulfonamides/therapeutic use , COVID-19 SerotherapyABSTRACT
The UK government recently decided to extend the interval between the first dose of the Pfizer BioNTech and AstraZeneca COVID-19 vaccines from 3 weeks to 12 weeks to maximise the number of people receiving the initial dose, despite the trials only providing vaccine efficacy data based on a schedule of 21 days between doses. This editorial discusses whether there is evidence to support this policy change.
Subject(s)
COVID-19 Vaccines , COVID-19 , Immunogenicity, Vaccine , Vaccination Coverage , Vaccination , COVID-19/epidemiology , COVID-19/immunology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/immunology , Drug Administration Schedule , Evidence-Based Medicine/methods , Evidence-Based Medicine/standards , Government Regulation , Health Policy/legislation & jurisprudence , Humans , Policy Making , SARS-CoV-2 , United Kingdom/epidemiology , Vaccination/methods , Vaccination/standards , Vaccination/statistics & numerical data , Vaccination Coverage/methods , Vaccination Coverage/standardsSubject(s)
Antirheumatic Agents/therapeutic use , COVID-19/prevention & control , Communicable Disease Control/trends , Immunosuppressive Agents/therapeutic use , Rheumatic Diseases/drug therapy , Rheumatology/trends , Antirheumatic Agents/adverse effects , COVID-19/immunology , COVID-19/transmission , Clinical Decision-Making , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Practice Patterns, Physicians'/trends , Rheumatic Diseases/immunology , Rheumatologists/trends , Risk Assessment , Risk FactorsABSTRACT
This editorial explores how technology has helped clinicians during the COVID-19 pandemic, from patient care to education, the changes that have been made and the numerous exciting possibilities of where technology can amalgamate with health care.
Subject(s)
COVID-19/epidemiology , Communications Media/trends , Delivery of Health Care/trends , Clinical Clerkship/trends , Education, Medical/trends , Humans , Mobile Applications , Pandemics , Patient Education as Topic/trends , Physical Distancing , SARS-CoV-2 , TelemedicineABSTRACT
The National Institute for Health and Care Excellence guidelines advise stopping immunosuppressive drugs for confirmed or suspected COVID-19 patients with autoimmune and inflammatory disorders. This may not be in the patient's best interest, given the potential long-term consequences of not managing chronic conditions, and immunosuppression may even be protective in those affected with COVID-19.
Subject(s)
Coronavirus Infections/immunology , Cytokine Release Syndrome/immunology , Deprescriptions , Immunosuppressive Agents/therapeutic use , Pneumonia, Viral/immunology , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Practice Guidelines as Topic , Prognosis , SARS-CoV-2 , Severity of Illness Index , United Kingdom/epidemiologyABSTRACT
Rheumatology patients who are taking immunosuppressants are considered to be at 'high risk' from COVID-19, hence have been self-isolating or shielding. However, they may be protected from the features of hyperinflammation driven by a 'cytokine storm', so may have better clinical outcomes if infected. This editorial discusses whether it may not be necessary to advise these patients to shield.