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1.
Rheumatol Int ; 40(9): 1353-1360, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-640396

RESUMEN

As of June 10th 2020 about 7.2 million individuals have tested positive for, and more than 410,000 have died due to COVID-19. In this review we outline the pathophysiology that underpins the potential use of anti-rheumatic therapies for severe COVID-19 infection and summarize the current evidence regarding the risk and outcome of COVID-19 in patients with systemic autoimmune diseases. Thus far there is no convincing evidence that any disease-modifying anti-rheumatic drug (conventional synthetic, biologic or targeted synthetic) including hydroxychloroquine, may protect against severe COVID-19 infection; answers about their possible usefulness in the management of the cytokine storm associated with severe COVID-9 infection will only arise from ongoing randomized controlled trials. Evidence on COVID-19 risk and outcome in patients with systemic autoimmune diseases is extremely limited; thus, any conclusions would be unsafe and should be seen with great caution. At present, the risk and severity (hospitalization, intensive care unit admission and death) of COVID-19 infection in people with autoimmune diseases do not appear particularly dissimilar to the general population, with the possible exception of hospitalization in patients exposed to high glucocorticoid doses. At this stage it is impossible to draw any conclusions for differences in COVID-19 risk and outcome between different autoimmune diseases and between the various immunomodulatory therapies used for them. More research in the field is obviously required, including as a minimum careful and systematic epidemiology and appropriately controlled clinical trials.


Asunto(s)
Antirreumáticos/uso terapéutico , Enfermedades Autoinmunes/tratamiento farmacológico , Infecciones por Coronavirus/tratamiento farmacológico , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Enfermedades Autoinmunes/epidemiología , Enfermedades Autoinmunes/inmunología , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Síndrome de Liberación de Citoquinas/inmunología , Humanos , Inhibidores de las Cinasas Janus/uso terapéutico , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Inhibidores del factor de Necrosis Tumorales/uso terapéutico
2.
RMD Open ; 6(2)2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-744887

RESUMEN

OBJECTIVES: Patients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of COVID-19. The influence of immunomodulating drugs on the course of COVID-19 is unknown. To gather knowledge about SARS-CoV-2 infections in patients with IRD, we established a registry shortly after the beginning of the pandemic in Germany. METHODS: Using an online questionnaire (www.COVID19-rheuma.de), a nationwide database was launched on 30 March 2020, with appropriate ethical and data protection approval to collect data of patients with IRD infected with SARS-CoV-2. In this registry, key clinical and epidemiological parameters-for example, diagnosis of IRD, antirheumatic therapies, comorbidities and course of the infection-are documented. RESULTS: Until 25 April 2020, data from 104 patients with IRD infected with SARS-CoV-2 were reported (40 males; 63 females; 1 diverse). Most of them (45%) were diagnosed with rheumatoid arthritis, 59% had one or more comorbidities and 42% were treated with biological disease-modifying antirheumatic drugs. Hospitalisation was reported in 32% of the patients. Two-thirds of the patients already recovered. Unfortunately, 6 patients had a fatal course. CONCLUSIONS: In a short time, a national registry for SARS-CoV2-infected patients with IRD was established. Within 4 weeks, 104 cases were documented. The registry enables to generate data rapidly in this emerging situation and to gain a better understanding of the course of SARS-CoV2-infection in patients with IRD, with a distinct focus on their immunomodulatory therapies. This knowledge is valuable for timely information of physicians and patients with IRD, and shall also serve for the development of guidance for the management of patients with IRD during this pandemic.


Asunto(s)
Antirreumáticos/uso terapéutico , Productos Biológicos/uso terapéutico , Infecciones por Coronavirus/fisiopatología , Neumonía Viral/fisiopatología , Sistema de Registros , Enfermedades Reumáticas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Artritis Psoriásica/complicaciones , Artritis Psoriásica/tratamiento farmacológico , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Femenino , Alemania , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , Hospitalización , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Polimialgia Reumática/complicaciones , Polimialgia Reumática/tratamiento farmacológico , Pronóstico , Enfermedades Reumáticas/complicaciones , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/tratamiento farmacológico , Adulto Joven
3.
Z Rheumatol ; 79(7): 686-691, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: covidwho-738390

RESUMEN

The recommendations of the German Society of Rheumatology (DGRh) update, which update and expand the guidance on the management of patients with inflammatory rheumatic diseases in view of SARS-CoV­2 created at the beginning of the COVID-19 pandemic, correspond in many points with the recommendations for action of the American (ACR) and European (EULAR) societies, but also differ in some points. Therefore, this article discusses the core recommendations of the DGRh update on the prevention of SARS-CoV-2/COVID-19, the risk assessment for inflammatory rheumatic diseases and the use of antirheumatic treatments in the context and in comparison to the ACR and EULAR recommendations, and provides an overview of the risk assessment of individual antirheumatic drugs.


Asunto(s)
Antirreumáticos/uso terapéutico , Infecciones por Coronavirus/epidemiología , Inflamación/terapia , Neumonía Viral/epidemiología , Enfermedades Reumáticas/terapia , Reumatología , Betacoronavirus , Europa (Continente) , Alemania , Humanos , Pandemias , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Sociedades Médicas , Estados Unidos
4.
Z Rheumatol ; 79(7): 686-691, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: covidwho-734832

RESUMEN

The recommendations of the German Society of Rheumatology (DGRh) update, which update and expand the guidance on the management of patients with inflammatory rheumatic diseases in view of SARS-CoV­2 created at the beginning of the COVID-19 pandemic, correspond in many points with the recommendations for action of the American (ACR) and European (EULAR) societies, but also differ in some points. Therefore, this article discusses the core recommendations of the DGRh update on the prevention of SARS-CoV-2/COVID-19, the risk assessment for inflammatory rheumatic diseases and the use of antirheumatic treatments in the context and in comparison to the ACR and EULAR recommendations, and provides an overview of the risk assessment of individual antirheumatic drugs.


Asunto(s)
Antirreumáticos/uso terapéutico , Infecciones por Coronavirus/epidemiología , Inflamación/terapia , Neumonía Viral/epidemiología , Enfermedades Reumáticas/terapia , Reumatología , Betacoronavirus , Europa (Continente) , Alemania , Humanos , Pandemias , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Sociedades Médicas , Estados Unidos
5.
BMJ Open Respir Res ; 7(1)2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-733150

RESUMEN

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group. CONCLUSION: HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Asociada a la Atención Médica/epidemiología , Hipoxia/terapia , Intubación Intratraqueal/estadística & datos numéricos , Terapia por Inhalación de Oxígeno/métodos , Neumonía Viral/terapia , Insuficiencia Respiratoria/terapia , Corticoesteroides/uso terapéutico , Afroamericanos , Anciano , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Azitromicina/uso terapéutico , Betacoronavirus , Cánula , Comorbilidad , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/epidemiología , Grupo de Ascendencia Continental Europea , Femenino , Cardiopatías/epidemiología , Hispanoamericanos , Humanos , Hidroxicloroquina/uso terapéutico , Hipertensión/epidemiología , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Philadelphia/epidemiología , Neumonía Asociada al Ventilador/epidemiología , Neumonía Viral/epidemiología , Quimioterapia por Pulso , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Fumar/epidemiología
6.
J Pediatr Gastroenterol Nutr ; 71(2): 153-155, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-729245

RESUMEN

Coronavirus disease 2019 (COVID-19) may lead to a severe inflammatory response referred to as a cytokine storm. We describe a case of severe COVID-19 infection in a recently diagnosed pediatric Crohn disease patient successfully treated with tumor necrosis factor-alpha (TNF-α) blockade. The patient presented with 5 days of fever, an erythematous maculopapular facial rash, and abdominal pain without respiratory symptoms. SARS-CoV-2 polymerase chain reaction was positive. Despite inpatient treatment for COVID-19 and a perianal abscess, the patient acutely decompensated, with worsening fever, tachycardia, fluid-refractory hypotension, elevation of liver enzymes, and transformation of the rash into purpura extending from the face to the trunk, upper and lower extremities, including the palmar and plantar surfaces of the hands and feet. Cytokine profile revealed rising levels of interleukin (IL)-6, IL-8, and TNF-α, higher than those described in either inflammatory bowel disease or severe COVID-19 alone. The patient was treated with infliximab for TNF-α blockade to address both moderately to severely active Crohn disease and multisystem inflammatory syndrome in children temporally related to COVID-19. Within hours of infliximab treatment, fever, tachycardia, and hypotension resolved. Cytokine profile improved with normalization of TNF-α, a decrease in IL-6, and IL-8 concentrations. This case supports a role for blockade of TNF-α in the treatment of COVID-19 inflammatory cascade. The role of anti-TNF agents in patients with multisystem inflammatory syndrome in children temporally related to COVID-19 requires further investigation.


Asunto(s)
Infecciones por Coronavirus/tratamiento farmacológico , Enfermedad de Crohn/complicaciones , Enfermedades Genéticas Ligadas al Cromosoma X/complicaciones , Eritrodermia Ictiosiforme Congénita/complicaciones , Infliximab/uso terapéutico , Interleucina-6/sangre , Interleucina-8/sangre , Deformidades Congénitas de las Extremidades/complicaciones , Neumonía Viral/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Anomalías Múltiples , Adolescente , Antirreumáticos/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Humanos , Masculino , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/virología , Factor de Necrosis Tumoral alfa/sangre
7.
Z Rheumatol ; 79(7): 710-717, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: covidwho-720358

RESUMEN

BACKGROUND: Reliable data on the course and treatment of pediatric COVID-19 ("corona virus disease 2019") in immunosuppressed patients with rheumatic diseases are missing. AIM: Delineation of individual strategies of the members of the Society for Pediatric Rheumatology (GKJR) in cases of COVID-19. METHODS: In May 2020 all GKJR members were invited to take part in an online survey. Opinion data regarding an approach using disease-modifying anti-rheumatic drugs (DMARD) in cases of COVID-19 as well as the readiness to use new therapeutic agents in patients in different stages of the disease were collected. RESULTS: A total of 71 respondents (27.3% of all contacted pediatric rheumatologists) took part in the survey. Of these 28.2% had treated patients with COVID-19. Over 95% of the respondents did not support a preventive adaptation of the anti-rheumatic treatment during the SARS-CoV­2 pandemic. In the case of outpatients under immunosuppression with proven COVID-19 more than 50% of the respondents would refrain from administering intravenous high-dose steroids, cyclophosphamide, anti-CD20 antibodies as well as BAFF, CTLA­4 and TNF-alpha blockades. Conversely, >70% of the respondents would continue the treatment with nonsteroidal anti-inflammatory drugs, hydroxychloroquine (HCQ), oral steroids, mycophenolate, IL­1 blockade and immunoglobulins (Ig). In the case of inpatients 74.6% of respondents would consider targeted COVID-19 treatment. In stable patients with oxygen treatment (stage I) HCQ (18.3%), azithromycin (16.9%) and Ig (9.9%) were most frequently used. In cases of early signs (stage II) or a manifest cytokine storm (stage III) anakinra (40.8% for stage II and 46.5% for stage III), tocilizumab (26.8% and 40.8%, respectively), steroids (25.4% and 33.8%, respectively) and remdesivir (29.6% and 38.0%, respectively) were most frequently used. The need for a personalized approach based on the current clinical situation was emphasized by many respondents. CONCLUSION: The currently low prevalence of COVID-19 in Germany limits the general clinical experience. Therefore, the presented results have to be interpreted with caution and mostly as hypothetical treatment considerations. It is to be expected that there will always be a limited amount of evidence on pediatric COVID-19; therefore, a continuous and critical exchange of expert opinions on the treatment strategies is important.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Reumatólogos , Antirreumáticos/uso terapéutico , Betacoronavirus , Niño , Infecciones por Coronavirus/tratamiento farmacológico , Alemania , Humanos , Pandemias , Encuestas y Cuestionarios
8.
Z Rheumatol ; 79(7): 710-717, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: covidwho-718416

RESUMEN

BACKGROUND: Reliable data on the course and treatment of pediatric COVID-19 ("corona virus disease 2019") in immunosuppressed patients with rheumatic diseases are missing. AIM: Delineation of individual strategies of the members of the Society for Pediatric Rheumatology (GKJR) in cases of COVID-19. METHODS: In May 2020 all GKJR members were invited to take part in an online survey. Opinion data regarding an approach using disease-modifying anti-rheumatic drugs (DMARD) in cases of COVID-19 as well as the readiness to use new therapeutic agents in patients in different stages of the disease were collected. RESULTS: A total of 71 respondents (27.3% of all contacted pediatric rheumatologists) took part in the survey. Of these 28.2% had treated patients with COVID-19. Over 95% of the respondents did not support a preventive adaptation of the anti-rheumatic treatment during the SARS-CoV­2 pandemic. In the case of outpatients under immunosuppression with proven COVID-19 more than 50% of the respondents would refrain from administering intravenous high-dose steroids, cyclophosphamide, anti-CD20 antibodies as well as BAFF, CTLA­4 and TNF-alpha blockades. Conversely, >70% of the respondents would continue the treatment with nonsteroidal anti-inflammatory drugs, hydroxychloroquine (HCQ), oral steroids, mycophenolate, IL­1 blockade and immunoglobulins (Ig). In the case of inpatients 74.6% of respondents would consider targeted COVID-19 treatment. In stable patients with oxygen treatment (stage I) HCQ (18.3%), azithromycin (16.9%) and Ig (9.9%) were most frequently used. In cases of early signs (stage II) or a manifest cytokine storm (stage III) anakinra (40.8% for stage II and 46.5% for stage III), tocilizumab (26.8% and 40.8%, respectively), steroids (25.4% and 33.8%, respectively) and remdesivir (29.6% and 38.0%, respectively) were most frequently used. The need for a personalized approach based on the current clinical situation was emphasized by many respondents. CONCLUSION: The currently low prevalence of COVID-19 in Germany limits the general clinical experience. Therefore, the presented results have to be interpreted with caution and mostly as hypothetical treatment considerations. It is to be expected that there will always be a limited amount of evidence on pediatric COVID-19; therefore, a continuous and critical exchange of expert opinions on the treatment strategies is important.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Reumatólogos , Antirreumáticos/uso terapéutico , Betacoronavirus , Niño , Infecciones por Coronavirus/tratamiento farmacológico , Alemania , Humanos , Pandemias , Encuestas y Cuestionarios
9.
Rheumatol Int ; 40(10): 1593-1598, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-713879

RESUMEN

OBJECTIVE: To describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization. METHODS: We identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization. RESULTS: A total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63; p = 0.018), previous lung disease (OR, 27.47; p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95; p = 0.019) were significantly associated to hospitalization. CONCLUSION: Neither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.


Asunto(s)
Artritis Psoriásica/tratamiento farmacológico , Artritis Reumatoide/tratamiento farmacológico , Infecciones por Coronavirus/fisiopatología , Glucocorticoides/uso terapéutico , Hospitalización/estadística & datos numéricos , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Neumonía Viral/fisiopatología , Anciano , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Antivirales/uso terapéutico , Artritis Psoriásica/complicaciones , Artritis Psoriásica/epidemiología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/epidemiología , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/tratamiento farmacológico , Enfermedades Autoinmunes/epidemiología , Azitromicina/uso terapéutico , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Combinación de Medicamentos , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Modelos Logísticos , Lopinavir/uso terapéutico , Enfermedades Pulmonares/epidemiología , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Estudios Retrospectivos , Ritonavir/uso terapéutico , Índice de Severidad de la Enfermedad , Factores Sexuales , España/epidemiología
10.
CNS Drugs ; 34(9): 879-896, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-709768

RESUMEN

The coronavirus 2019 (COVID-19) pandemic is expected to linger. Decisions regarding initiation or continuation of disease-modifying therapy for multiple sclerosis have to consider the potential relevance to the pandemic. Understanding the mechanism of action and the possible idiosyncratic effects of each therapeutic agent on the immune system is imperative during this special time. The infectious side-effect profile as well as the route and frequency of administration of each therapeutic agent should be carefully considered when selecting a new treatment or deciding on risk mitigation strategies for existing therapy. More importantly, the impact of each agent on the future severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2) vaccine should be carefully considered in treatment decisions. Moreover, some multiple sclerosis therapies may have beneficial antiviral effects against SARS-CoV-2 while others may have beneficial immune-modulating effects against the cytokine storm and hyperinflammatory phase of the disease. Conventional injectables have a favorable immune profile without an increased exposure risk and therefore may be suitable for mild multiple sclerosis during the pandemic. However, moderate and highly active multiple sclerosis will continue to require treatment with oral or intravenous high-potency agents but a number of risk mitigation strategies may have to be implemented. Immune-modulating therapies such as the fumerates, sphinogosine-1P modulators, and natalizumab may be anecdotally preferred over cell-depleting immunosuppressants during the pandemic from the immune profile standpoint. Within the cell-depleting agents, selective (ocrelizumab) or preferential (cladribine) depletion of B cells may be relatively safer than non-selective depletion of lymphocytes and innate immune cells (alemtuzumab). Patients who develop severe iatrogenic or idiosyncratic lymphopenia should be advised to maintain social distancing even in areas where lockdown has been removed or ameliorated. Patients with iatrogenic hypogammaglobulinemia may require prophylactic intravenous immunoglobulin therapy in certain situations. When the future SARS-CoV-2 vaccine becomes available, patients with multiple sclerosis should be advised that certain therapies may interfere with mounting a protective immune response to the vaccine and that serological confirmation of a response may be required after vaccination. They should also be aware that most multiple sclerosis therapies are incompatible with live vaccines if a live SARS-CoV-2 vaccine is developed. In this article, we review and compare disease-modifying therapies in terms of their effect on the immune system, published infection rates, potential impact on SARS-CoV-2 susceptibility, and vaccine-related implications. We propose risk mitigation strategies and practical approaches to disease-modifying therapy during the COVID-19 pandemic.


Asunto(s)
Antirreumáticos/farmacología , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus , Sistema Inmunológico/efectos de los fármacos , Esclerosis Múltiple , Pandemias , Neumonía Viral , Vacunas Virales/farmacología , Betacoronavirus/fisiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/terapia , Humanos , Esclerosis Múltiple/tratamiento farmacológico , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/inmunología , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/terapia , Ajuste de Riesgo
11.
Cells ; 9(8)2020 08 11.
Artículo en Inglés | MEDLINE | ID: covidwho-706247

RESUMEN

The development of biological disease-modifying antirheumatic drugs (bDMARDs) and target synthetic DMARDs (tsDMARDs), also known as small molecule inhibitors, represent a breakthrough in rheumatoid arthritis (RA) treatment. The tsDMARDs are a large family of small molecules targeting mostly the several types of kinases, which are essential in downstream signaling of pro-inflammatory molecules. This review highlights current challenges associated with the treatment of RA using small molecule inhibitors targeting intracellular JAKs/MAPKs/NF-κB/SYK-BTK signaling pathways. Indeed, we have provided the latest update on development of small molecule inhibitors, their clinical efficacy and safety as a strategy for RA treatment. On the other hand, we have highlighted the risk and adverse effects of tsDMARDs administration including, among others, infections and thromboembolism. Therefore, performance of blood tests or viral infection screening should be recommended before the tsDMARDs administration. Interestingly, recent events of SARS-CoV-2 outbreak have demonstrated the potential use of small molecule inhibitors not only in RA treatment, but also in fighting COVID-19 via blocking the viral entry, preventing of hyperimmune activation and reducing cytokine storm. Thus, small molecule inhibitors, targeting wide range of pro-inflammatory singling pathways, may find wider implications not only for the management of RA but also in the controlling of COVID-19.


Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Betacoronavirus/fisiología , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Animales , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Citocinas/inmunología , Citocinas/metabolismo , Quimioterapia Combinada , Humanos , Inflamación/inmunología , Inflamación/metabolismo , Ratones , Pandemias , Neumonía Viral/inmunología , Neumonía Viral/virología , Transducción de Señal/efectos de los fármacos , Resultado del Tratamiento , Internalización del Virus/efectos de los fármacos
13.
Curr Opin Rheumatol ; 32(5): 429-433, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-704674

RESUMEN

PURPOSE OF REVIEW: There are currently many unanswered questions surrounding the management of patients with immune-mediated inflammatory diseases during the COVID-19 pandemic and several 'rapid' guidelines have been released, although are subject to be updated and changed in the near future. The purpose of this review is to discuss the approach to management of patients with immune-mediated diseases during the COVID-19 pandemic. RECENT FINDINGS: At present, there is little evidence to suggest an increased risk of COVID-19 infection or its complications in patients with immune-mediated diseases or associated with conventional or biologic disease modifying antirheumatic drugs; however, glucocorticoid use does appear to have negative associations. SUMMARY: Currently, conventional and biologic disease modifying antirheumatic drugs can be continued in the absence of SARS-CoV-2 exposure. In the case of exposure, with the exception of hydroxyhcloroquine and sulfasalazine, immunosuppression should be held for 2 weeks. Our recommendations and the guidelines we discuss here are based on C-level recommendations but help provide a framework for how to counsel our patients during this pandemic.


Asunto(s)
Antirreumáticos/uso terapéutico , Betacoronavirus , Competencia Clínica , Infecciones por Coronavirus/epidemiología , Inmunosupresión/métodos , Neumonía Viral/epidemiología , Enfermedades Reumáticas/tratamiento farmacológico , Reumatólogos/normas , Comorbilidad , Humanos , Pandemias , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/epidemiología
14.
Clin Rheumatol ; 39(9): 2789-2796, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-679750

RESUMEN

BACKGROUND: Over the month of April, Spain has become the European country with more confirmed cases of COVID-19 infection, after surpassing Italy on April 2nd. The community of Castile and León in Spain is one of the most affected by COVID-19 infection and the province of León has a total of 3711 cases and 425 deaths so far. Rheumatic patients should be given special attention regarding COVID-19 infection due to their immunocompromised state resulting from their underlying immune conditions and use of targeted immune-modulating therapies. Studying epidemiological and clinical characteristics of patients with rheumatic diseases infected with SARS-CoV2 is pivotal to clarify determinants of COVID-19 disease severity in patients with underlying rheumatic disease. OBJECTIVES: To describe epidemiological characteristics of patients with rheumatic diseases hospitalized with COVID-19 and determine risk factors associated with mortality in a third level Hospital setting in León, Spain. METHODS: We performed a prospective observational study, from 1st March 2020 until the 1st of June including adults with rheumatic diseases hospitalized with COVID-19 and performed a univariate and multivariate logistic regression model to estimate ORs and 95% CIs of mortality. Age, sex, comorbidities, rheumatic disease diagnosis and treatment, disease activity prior to infection, radiographic and laboratorial results at arrival were analysed. RESULTS: During the study period, 3711 patients with COVID-19 were admitted to our hospital, of whom 38 (10%) had a rheumatic or musculoskeletal disease. Fifty-three percent were women, with a mean age at hospital admission of 75.3 (IQR 68-83) years. The median length of stay was 11 days. A total of 10 patients died (26%) during their hospital admission. Patients who died from COVID-19 were older (median age 78.4 IQR 74.5-83.5) than those who survived COVID-19 (median age 75.1 IQR 69.3-75.8) and more likely to have arterial hypertension (9 [90%] vs 14 [50%] patients; OR 9 (95% CI 1.0-80.8), p 0.049), dyslipidaemia (9 (90%) vs 12 (43%); OR 12 (95% CI 1.33-108), p 0.03), diabetes ((9 (90%) vs 6 (28%) patients; OR 33, p 0.002), interstitial lung disease (6 (60%) vs 6 (21%); OR 5.5 (95% CI 1.16-26), p 0.03), cardiovascular disease (8 (80%) vs 11 (39%); OR 6.18 (95% IC 1.10-34.7, p 0.04) and a moderate/high index of rheumatic disease activity (7 (25%) vs 6(60%); OR 41.4 (4.23-405.23), p 0.04). In univariate analyses, we also found that patients who died from COVID-19 had higher hyperinflammation markers than patients who survived: C-reactive protein (181 (IQR 120-220) vs 107.4 (IQR 30-150; p 0.05); lactate dehydrogenase (641.8 (IQR 465.75-853.5) vs 361 (IQR 250-450), p 0.03); serum ferritin (1026 (IQR 228.3-1536.3) vs 861.3 (IQR 389-1490.5), p 0.04); D-dimer (12,019.8 (IQR 843.5-25,790.5) vs 1544.3 (IQR 619-1622), p 0.04). No differences in sex, radiological abnormalities, rheumatological disease, background therapy or symptoms before admission between deceased patients and survivors were found. In the multivariate analysis, the following risk factors were associated with mortality: rheumatic disease activity (p = 0.003), dyslipidaemia (p = 0.01), cardiovascular disease (p = 0.02) and interstitial lung disease (p = 0.02). Age, hypertension and diabetes were significant predictors in univariate but not in multivariate analysis. Rheumatic disease activity was significantly associated with fever (p = 0.05), interstitial lung disease (p = 0.03), cardiovascular disease (p = 0.03) and dyslipidaemia (p = 0.01). CONCLUSIONS: Our results suggest that comorbidities, rheumatic disease activity and laboratorial abnormalities such as C-reactive protein (CRP), D-Dimer, lactate dehydrogenase (LDH), serum ferritin elevation significantly associated with mortality whereas previous use of rheumatic medication did not. Inflammation is closely related to severity of COVID-19. Key Points • Most patients recover from COVID-19. • The use of DMARDs, corticosteroids and biologic agents did not increase the odds of mortality in our study. • Rheumatic disease activity might be associated with mortality.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Enfermedades Reumáticas/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Antivirales/uso terapéutico , Betacoronavirus , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Diabetes Mellitus/epidemiología , Combinación de Medicamentos , Dislipidemias/epidemiología , Femenino , Ferritinas/sangre , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hospitalización , Humanos , Hidroxicloroquina/uso terapéutico , Hipertensión/epidemiología , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , L-Lactato Deshidrogenasa/sangre , Tiempo de Internación , Lopinavir/uso terapéutico , Enfermedades Pulmonares Intersticiales/epidemiología , Masculino , Mortalidad , Oportunidad Relativa , Pandemias , Neumonía Viral/sangre , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Estudios Prospectivos , Enfermedades Reumáticas/fisiopatología , Factores de Riesgo , Ritonavir/uso terapéutico , Índice de Severidad de la Enfermedad , España/epidemiología
15.
Clin Rheumatol ; 39(9): 2803-2810, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-679748

RESUMEN

COVID-19 has become a global concern. A large number of reports have explained the clinical characteristics and treatment strategies of COVID-19, but the characteristics and treatment of COVID-19 patient with systemic lupus erythematosus (SLE) are still unclear. Here, we report the clinical features and treatment of the first SLE patient with confirmed COVID-19 pneumonia. This was a 39-year-old woman, diagnosed with SLE 15 years ago, whose overall clinical characteristics (symptoms, laboratory tests, and chest CTs) were similar to those of the general COVID-19 patients. She continued to take the previous SLE drugs (doses of glucocorticoids, hydroxychloroquine, and immunosuppressive agents were not reduced) and was treated with strict antiviral and infection prevention treatment. After the first discharge, she got a recurrence of COVID-19 during her home isolation, and then returned to hospital and continued the previous therapy. Finally, this long-term immune suppressive patient's COVID-19 was successfully cured. The successful recovery of this case has significant reference value for the future treatment of COVID-19 patients with SLE. Key Points • COVID-19 patients with SLE is advocated to continue the medical treatment for SLE. • Hydroxychloroquine may have potential benefits for COVID-19 patients with SLE. • COVID-19 patients with SLE is prone to relapse, and multiple follow-ups are necessary.


Asunto(s)
Antirreumáticos/uso terapéutico , Antivirales/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Hidroxicloroquina/uso terapéutico , Inmunosupresores/uso terapéutico , Lopinavir/uso terapéutico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , ARN Viral , Ritonavir/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Combinación de Medicamentos , Femenino , Humanos , Pulmón/diagnóstico por imagen , Lupus Eritematoso Sistémico/complicaciones , Moxifloxacino/uso terapéutico , Ácido Micofenólico/uso terapéutico , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Prednisona/uso terapéutico , Recurrencia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tomografía Computarizada por Rayos X
16.
Clin Rheumatol ; 39(9): 2817-2821, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-671236

RESUMEN

COVID-19 has significantly affected healthcare systems around the world. To prepare for this unprecedented emergency, elective patient care was put on hold across the National Health Service (NHS). Rheumatology service had to be reorganised with a cancellation of elective clinics and clinical reconfiguration to continue to deliver care to patients, support frontline, and prevent viral transmission. The rheumatology community's responsibility of providing a continuity of care for patients had to be balanced with measures to reduce the risk of viral transmission and also protection of both the patients and staff. We describe our experience of delivering rheumatology service as recommended by the National Institute for Health and Care Excellence (NICE NG167) guidelines at a district general hospital during the current pandemic. Key Points • Prepare to deliver a rapid mass communication; ensure email and mobile phones registered in patients' records; enable access to text and video messaging. • To ensure wider access to innovative digital technology in clinical practice; implement telephone and video consultations where appropriate. • To consider setting up community OP clinics, for example, mobile and satellite clinics.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/métodos , Neumonía Viral/epidemiología , Enfermedades Reumáticas/terapia , Reumatología/métodos , Telemedicina , Administración Intravenosa , Atención Ambulatoria , Antirreumáticos/uso terapéutico , Betacoronavirus , Continuidad de la Atención al Paciente , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Sustitución de Medicamentos , Hospitales de Distrito , Hospitales Generales , Humanos , Infusiones Subcutáneas , Enfermeras y Enfermeros , Pandemias/prevención & control , Admisión y Programación de Personal , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Reumatólogos , Medición de Riesgo , Medicina Estatal , Reino Unido
17.
Rheumatol Int ; 40(10): 1599-1611, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-670422

RESUMEN

The aim of this work is to trace how rheumatologists all over Egypt are approaching the COVID-19 pandemic and what changes it has brought about in the patients' care with special attention to its effect on vulnerable rheumatic disease (RD) patients. This survey further aims to help inform the rheumatology community about the changes in practice during the COVID-19 pandemic. The survey included 26 questions distributed to University staff members across Egypt members of the Egyptian College of Rheumatology (ECR). It takes 5-10 min to fill out. The practice setting of participating rheumatologists included University Teaching Hospitals that are the main rheumatology and clinical immunology service providers for adults and children RD patients. There was an overall agreement across the country in the responses to the survey that took a median time of 7 min to fill in. Potential changes in rheumatology outpatient practice by staff members evolved since the COVID-19 pandemic. None of the university rheumatology staff members has prescribed chloroquine or HCQ to prevent or treat COVID-19 in a non-hospitalized patient who was not previously on it. Twenty-three recommended decrease/avoid NSAIDs if the RD patient had confirmed COVID-19 or symptoms. There is an agreement to the key emerging frontline role of rheumatologists in treating COVID-19. During the pandemic, RD cases requiring admission were dealt with by several modified strategies. The overall agreement among the different university rheumatology departments during such critical situation has provoked the ECR to consider providing provisional guidelines for dealing with RD patients during this global catastrophe.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedades Reumáticas/tratamiento farmacológico , Reumatólogos/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Antirreumáticos/provisión & distribución , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/prevención & control , Deprescripciones , Egipto/epidemiología , Humanos , Hidroxicloroquina/provisión & distribución , Hidroxicloroquina/uso terapéutico , Pandemias/prevención & control , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/prevención & control , Reumatología , Encuestas y Cuestionarios
18.
Clin Immunol ; 219: 108544, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-664013

RESUMEN

Glucose 6-phosphate dehydrogenase (G6PD) deficiency facilitates human coronavirus infection due to glutathione depletion. G6PD deficiency may especially predispose to hemolysis upon coronavirus disease-2019 (COVID-19) infection when employing pro-oxidant therapy. However, glutathione depletion is reversible by N-acetylcysteine (NAC) administration. We describe a severe case of COVID-19 infection in a G6PD-deficient patient treated with hydroxychloroquine who benefited from intravenous (IV) NAC beyond reversal of hemolysis. NAC blocked hemolysis and elevation of liver enzymes, C-reactive protein (CRP), and ferritin and allowed removal from respirator and veno-venous extracorporeal membrane oxygenator and full recovery of the G6PD-deficient patient. NAC was also administered to 9 additional respirator-dependent COVID-19-infected patients without G6PD deficiency. NAC elicited clinical improvement and markedly reduced CRP in all patients and ferritin in 9/10 patients. NAC mechanism of action may involve the blockade of viral infection and the ensuing cytokine storm that warrant follow-up confirmatory studies in the setting of controlled clinical trials.


Asunto(s)
Acetilcisteína/uso terapéutico , Antioxidantes/uso terapéutico , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/tratamiento farmacológico , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Deficiencia de Glucosafosfato Deshidrogenasa/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Adulto , Antirreumáticos/uso terapéutico , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Síndrome de Liberación de Citoquinas/sangre , Síndrome de Liberación de Citoquinas/complicaciones , Síndrome de Liberación de Citoquinas/virología , Esquema de Medicación , Ferritinas/sangre , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Deficiencia de Glucosafosfato Deshidrogenasa/sangre , Deficiencia de Glucosafosfato Deshidrogenasa/complicaciones , Deficiencia de Glucosafosfato Deshidrogenasa/virología , Humanos , Hidroxicloroquina/uso terapéutico , Inflamación/prevención & control , Masculino , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/virología , Resultado del Tratamiento
19.
J Clin Rheumatol ; 26(6): 224-228, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-660018

RESUMEN

OBJECTIVE: With hydroxychloroquine (HCQ) and chloroquine (CQ) emerging as potential therapies for coronavirus disease 2019 (COVID-19), shortages have been reported. We aimed to understand how rheumatologists, one of the most common prescribers of HCQ/CQ, prescribed these medications to manage COVID-19 and to understand if their patients are affected by shortages. METHODS: Between April 8 and April 27, 2020, an online survey was distributed to a convenience sample of rheumatologists who practice medicine in a diverse range of settings globally, resulting in 506 responses. Adjusted Poisson regression models were calculated. RESULTS: Only 6% of respondents prescribed HCQ/CQ for COVID-19 prophylaxis, and only 12% for outpatient treatment of COVID-19. Compared to the United States, the likelihood of prescribing HCQ/CQ for prophylaxis was higher in India (adjusted risk ratio [aRR], 6.7; 95% confidence interval [CI], 2.7-16.8; p < 0.001). Further, compared to the United States and those with 1 to 5 years of experience, rheumatologists in Europe (aRR, 2.9; 95% CI, 1.6-5.3; p < 0.001) and those with 10+ years of experience (11-20 years: aRR, 2.5; 95% CI, 1.2-5.3; p = 0.015; 21+ years: aRR = 3.3; 95% CI, 1.4-7.4; p = 0.004) had a higher likelihood of prescribing HCQ/CQ for outpatient treatment. Of note, 71% of all rheumatologists reported that their patients were directly affected by HCQ/CQ shortages. CONCLUSION: The results suggest that only a small percentage of rheumatologists are prescribing HCQ/CQ for prophylaxis or outpatient treatment of COVID-19. Medication shortages experienced by large numbers of autoimmune disease patients are concerning and should play a role in decisions, especially given poor efficacy data for HCQ/CQ in COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Hidroxicloroquina/uso terapéutico , Pandemias/prevención & control , Neumonía Viral/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Reumatología , Antirreumáticos/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Neumonía Viral/epidemiología , Encuestas y Cuestionarios
20.
Curr Opin Rheumatol ; 32(5): 441-448, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-649700

RESUMEN

PURPOSE OF REVIEW: Assimilating and disseminating information during the novel coronavirus disease 2019 (COVID-19) has been challenging. The purpose of this review is to identify specific threats to the validity of the COVID-19 literature and to recommend resources for practicing rheumatologists and their patients. RECENT FINDINGS: The COVID-19 literature has rapidly expanded and includes 17 998 publications through May of 2020, 1543 of which also address rheumatic disease-related topics. Specific obstacles to acquiring high-quality information have arisen, including 'pandemic research exceptionalism' and a 'parallel pandemic' of misinformation. Unique challenges to rheumatologists include specific interest in antirheumatic disease therapies and a paucity of rheumatology-specific information. Patients with rheumatic diseases have faced shortages of critical medications and a lack of information tailored to their health conditions and medications. SUMMARY: We recommend rheumatologists develop a system to acquire high-quality information and offer guiding principles for triaging specific resources, which include relevance, accessibility, credibility, timeliness, and trustworthiness. The same principles can be applied to selecting patient oriented resources. Specific trustworthy resources are recommended.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Enfermedades Reumáticas , Antirreumáticos/uso terapéutico , Infecciones por Coronavirus/complicaciones , Humanos , Selección de Paciente , Neumonía Viral/complicaciones , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/tratamiento farmacológico
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