Background/Purpose: There are very few studies reporting COVID-19 in patients with rheumatic diseases, without clear evidence supporting more frequent or severe disease in these patients. Nevertheless, to our knowledge, there are no studies analysing Rituximab effect within autoimmune diseases. The aim is t o describe the impact and outcome of SARS-CoV-2 infection in our cohort of patients with rheumatic diseases treated with Rituximab.

Methods: A retrospective, descriptive study was conducted on patients treated with Rituximab followed in the rheumatology unit of a referral hospital.  Patients were screened by telephone interview and a comprehensive review of health records from 01/02/2020 to 22/05/2020. Patients were classified in 4 groups: Non suspected infection (asymptomatic), suspected infection (compatible symptoms not confirmed), inpatients with confirmed infection, deceased patients with confirmed infection. The clinical characteristics and outcome of these 4 groups were described.

Results: Seventy-six patients treated with Rituximab were reviewed. Among the 76 patients, 63 (82,8%) were classified as non suspected SARS-COV 2 infection, 5 (6,6%) had a suspected non confirmed infection, 5 (6,6%) were admitted to hospital with confirmed infection and 3 (4%) were admitted to hospital and died during hospitalization. Their baseline characteristics according to infection severity are described in table 1. At the beginning of COVID19 outbreak, 76,9% of patients were on remission of their rheumatic disease, 15,4% had low disease activity and 7,7% had active disease despite treatment.

First symptom reported was fever (30,8%) followed by cough (23,1%) and myalgia (15,4%).  SARS-COV2 treatment and chest-x-ray findings are reported in table 2.

Severe SARS-COV2 infection was developed in 61,5% of patients (8/13), requiring hospitalization. Patients were hospitalized a median of 10 days [range (4-29)] and 62,5% (5/8) of patients experienced a clinical worsening after >10 days from symptoms onset. Inpatients had a higher rate of comorbidities: mainly HTA, COPD and CV disease. Up to 75% of inpatients had pulmonary involvement, being ILD the most frequent (4/6 66,7%). Respiratory insufficiency was present in 87,5% of hospitalized patients, 3/7 (42,9%) required non-invasive mechanical ventilation and 5/8 (62.5%) fulfilled ARDS criteria (PAFI< 300 and bilateral pneumonia).

Three out of eight (37,5%) patients died during hospitalization, all having 3 or more comorbidities. One longstanding RA patient with ILD complicated with a pulmonary embolism despite prophylactic heparin, a SLE patient with Evans Syndrome and COPD with chronic supplementary oxygen and an ANCA-vasculitis with renal and pulmonary involvement.

Conclusion: In our cohort of patients treated with Rituximab we found a high rate of hospitalization and death. Rituximab treatment might be taken into consideration as a risk factor for severe SARS-COV-2 infection in rheumatic patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cohort-of-rheumatic-patients-treated-with-rituximab-and-covid-19-does-rituximab-treatment-increases-the-severity-of-sars-cov2-infection/