Background/Purpose: Following the first documented Florida case of COVID-19 on March 1, 2020, our community rheumatology practice continued to administer biologic infusion therapy with concern as to the outcome of exposure to COVD-19 in this patient population.

Methods: Point-of-care COVID-19 antibody testing was initiated prior to all infusions from April 28, 2020, using the RayBiotech or Healgen COVID-19 IgM/IgG Rapid Test Kit. During this three month period a review of the medical records revealed a total of 255 unique infusion patients screened for COVID-19, 185 females and 70 males, age 16 to 92 with a mean age of 58. Underlying diagnoses included AS, GCA, hidradenitis suppurativa, IBD, MS, myasthenia gravis, PSA, RA, and SLE. Treatments included infliximab (51.8%), rituximab (12.9%), golimumab (10.2%), abatacept, belimumab, ocrelizumab, tocilizumab, ustekinumab, and vedolizumab.

IgM positive patients were not infused and were asked to get confirmatory PCR testing done, quarantine for two weeks, and needed to test negative for IgM before infusions were restarted. All staff wore appropriate PPE, had daily body temperatures checked, and were tested for COVID weekly.

Results: On April 28, 2020 there were 11,831 confirmed COVID-19 cases in Dade County (the county in which this practice resides)¹, and by June 16, 2020 Dade County reported 22,741 confirmed cases of COVID-19, with 3,497 hospitalizations (16% of all cases) and 847 reported deaths (4% of all cases)².

Of the 255 unique infusion patients screened in this period, six tested positive for both COVID-19 IgM and Ig G antibodies (2.67% of patients) while four patients (1.57%) tested positive for COVID-19 IgG antibodies alone. None of these patients required hospitalization and none had experienced severe COVID-19 symptoms or disease. All experienced negligible or only mild symptoms when questioned by the provider about current or historical diagnosis following their positive test results.

Conclusion: Considering the level of community spread occurring in our area, we were surprised to find how few of our patients on biologic therapy tested positive for COVID-19 antibodies, and furthermore, how few of those who tested positive experienced symptoms. This appears to support the concept that cytokine inhibition from the use of biologic infusion therapy and possibly may in fact provide some protective mechanism to this group of patients and may arguably reduce the clinical consequences following infection^3,4. To be noted, background steroids were utilized in a high percentage of our patients. In the past, this facility, amongst others, has reported a potential benefit and lack of toxicity with the use of biologic therapies in the face of HIV and Hepatitis C infections.⁵ Further investigation would be warranted to determine if there is any anti-COVID-19 benefit prophylactically and therapeutically from the various immune modulators currently used in the clinical rheumatology space.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-incidence-of-coronavirus-disease-2019-covid-19-infection-in-patients-on-biologic-infusion-therapies-at-a-community-rheumatology-practice/