THE COURSE of NOVEL CORONAVIRUS DISEASE 2019 (COVID-19) in PATIENTS with IGG4-RELATED DISEASE TREATED with RITUXIMAB

ABSTRACT

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) raised many questions and concerns about the safety of different immunosuppressive agents in patients (pts) with rheumatic diseases during the pandemic. There is some data that anti-B-cell depletion strategies could lead to more severe disease course. Rituximab (RTM) is one of the most effective, safe and well tolerated agents in IgG4-related disease (IgG4-RD) treatment. Information about the course of COVID-19 in pts with IgG4-RD is lacking. Objectives: To examine clinical course of COVID-19 in pts with IgG4-RD treated with anti-CD20 monoclonal antibody (RTM). Methods: Single center observational study. We searched in our clinical base from 2019 to 2021 years for pts with IgG4-RD, treated with RTM within this period. Diagnosis of IgG4-RD was based on comprehensive diagnostic criteria (H. Umehara, 2011). COVID-19 infection was registered when PCR test results were positive. RTM was administered in two 1000 mg infusions 14 days apart for the 1st course, then 500 mg every 6 months. We used mean ± standard deviation and median values with interquartile range of 25-75 percentile to characterize quantitative data. Results: Fifteen pts, 6 women and 9 men, mean age 53.2 ± 12 years, receiving RTM monotherapy were included. The majority of patients (80%) had multiple organ involvement, mean number 2,3 (from 1 to 5) dacryadenitis-11 pts, sialadenitis-10 pts, AIP 1-4 pts, lung disease-3 pts, sclerosing cholangiris-2 pts, kidney disease-2 pts, retroperitoneal fbrosis-1 pt, aortitis-1 pt, prostatitis-1 pt. Median duration of IgG4-RD before COVID-19 onset was 48 [27;72] months, median duration of RTM treatment was 22 [11,5;30,5] months and median time from the last dose of RTM was 2 [1;4,5] months. Three pts had arterial hypertension or coronary heart disease anamnesis, 4 pts had asthma, 2 pts were overweight and 1 had class 3 obesity. No pts were vaccinated against SARS-CoV-2. Six patients (40%) required hospitalization and 4 of them received IL-6 inhibitors, only 1 required mechanical lung ventilation, 6 patients (40%) had only minor symptoms and didn't require any specifc treatment, glucocorticoids were administered to 8 patients. All patients, except one, were older than 50, but they didn't have severe comorbidities. One patient, a 46 year-old man with a long anamnesis of IgG4-related dacryo-and sialad-enitis, bronchial asthma, arterial hypertension class 3 and class 3 obesity, died. Due to small number of studied pts no statistical correlations could be established. Conclusion: The proportion of hospitalized pts with IgG4-RD and RTM treatment was surprisingly high. The worst course was in patient with severe comorbidity. It appears that RTM can have negative impact on susceptibility to COVID-19 and its disease course.