tetano
Editor, Senior Moderator
ACR Open Rheumatol
. 2021 Dec 10.
doi: 10.1002/acr2.11386. Online ahead of print.
Coronavirus Disease 2019 Outcomes Among Recipients of Anti-CD20 Monoclonal Antibodies for Immune-Mediated Diseases: A Comparative Cohort Study
Naomi J Patel[SUP] 1 [/SUP], Kristin M D'Silva[SUP] 1 [/SUP], Tiffany Y-T Hsu[SUP] 2 [/SUP], Michael DiIorio[SUP] 2 [/SUP], Xiaoqing Fu[SUP] 1 [/SUP], Claire Cook[SUP] 1 [/SUP], Lauren Prisco[SUP] 2 [/SUP], Lily Martin[SUP] 2 [/SUP], Kathleen M M Vanni[SUP] 2 [/SUP], Alessandra Zaccardelli[SUP] 2 [/SUP], Yuqing Zhang[SUP] 1 [/SUP], Jeffrey A Sparks[SUP] 2 [/SUP], Zachary S Wallace[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: Patients with immune-mediated diseases treated with anti-CD20 monoclonal antibodies may have worse coronavirus disease 2019 (COVID-19) outcomes due to impaired humoral immunity, but differences compared with the general population are unknown.
Methods: We identified patients with immune-mediated diseases who received anti-CD20 monoclonal antibodies within 1 year prior to the index date of polymerase chain reaction-confirmed COVID-19 between January 31, 2020, and January 31, 2021. General population comparators with COVID-19 were matched up 5:1 by age, sex, and polymerase chain reaction date. Unadjusted and multivariable adjusted (for age, race, body mass index, and Charlson Comorbidity Index) hazard ratios (HRs) and 95% confidence intervals (CIs) for hospitalization, mechanical ventilation, and death in recipients of anti-CD20 monoclonal antibodies versus comparators were estimated by using Cox regression.
Results: We identified 114 cases patients COVID-19 who had received anti-CD20 monoclonal antibodies for immune-mediated diseases (mean age 55 years, 70% female) and 559 matched comparators with COVID-19 (mean age 54 years, 70% female). Patients treated with anti-CD20 monoclonal antibodies had higher mortality (adjusted HR 2.16; 95% CI: 1.03-4.54) than matched comparators. Risks of hospitalization (adjusted HR 0.88; 95% CI: 0.62-1.26) and mechanical ventilation use (adjusted HR 0.82; 95% CI: 0.36-1.87) were similar. Similar trends were seen in analyses according to type of indication (eg, rheumatic or neurologic disease) and duration of anti-CD20 monoclonal antibody use (<1 or ≥1 year) and after patients with interstitial lung disease, those with cancer, and those on glucocorticoids prior to COVID-19 diagnosis were excluded.
Conclusion: Patients who received anti-CD20 monoclonal antibodies for immune-mediated diseases prior to COVID-19 had higher mortality following COVID-19 than matched comparators, highlighting the urgent need to mitigate excess risks in recipients of anti-CD20 monoclonal antibodies during the ongoing pandemic.
. 2021 Dec 10.
doi: 10.1002/acr2.11386. Online ahead of print.
Coronavirus Disease 2019 Outcomes Among Recipients of Anti-CD20 Monoclonal Antibodies for Immune-Mediated Diseases: A Comparative Cohort Study
Naomi J Patel[SUP] 1 [/SUP], Kristin M D'Silva[SUP] 1 [/SUP], Tiffany Y-T Hsu[SUP] 2 [/SUP], Michael DiIorio[SUP] 2 [/SUP], Xiaoqing Fu[SUP] 1 [/SUP], Claire Cook[SUP] 1 [/SUP], Lauren Prisco[SUP] 2 [/SUP], Lily Martin[SUP] 2 [/SUP], Kathleen M M Vanni[SUP] 2 [/SUP], Alessandra Zaccardelli[SUP] 2 [/SUP], Yuqing Zhang[SUP] 1 [/SUP], Jeffrey A Sparks[SUP] 2 [/SUP], Zachary S Wallace[SUP] 1 [/SUP]
Affiliations
- PMID: 34890478
- DOI: 10.1002/acr2.11386
Abstract
Objective: Patients with immune-mediated diseases treated with anti-CD20 monoclonal antibodies may have worse coronavirus disease 2019 (COVID-19) outcomes due to impaired humoral immunity, but differences compared with the general population are unknown.
Methods: We identified patients with immune-mediated diseases who received anti-CD20 monoclonal antibodies within 1 year prior to the index date of polymerase chain reaction-confirmed COVID-19 between January 31, 2020, and January 31, 2021. General population comparators with COVID-19 were matched up 5:1 by age, sex, and polymerase chain reaction date. Unadjusted and multivariable adjusted (for age, race, body mass index, and Charlson Comorbidity Index) hazard ratios (HRs) and 95% confidence intervals (CIs) for hospitalization, mechanical ventilation, and death in recipients of anti-CD20 monoclonal antibodies versus comparators were estimated by using Cox regression.
Results: We identified 114 cases patients COVID-19 who had received anti-CD20 monoclonal antibodies for immune-mediated diseases (mean age 55 years, 70% female) and 559 matched comparators with COVID-19 (mean age 54 years, 70% female). Patients treated with anti-CD20 monoclonal antibodies had higher mortality (adjusted HR 2.16; 95% CI: 1.03-4.54) than matched comparators. Risks of hospitalization (adjusted HR 0.88; 95% CI: 0.62-1.26) and mechanical ventilation use (adjusted HR 0.82; 95% CI: 0.36-1.87) were similar. Similar trends were seen in analyses according to type of indication (eg, rheumatic or neurologic disease) and duration of anti-CD20 monoclonal antibody use (<1 or ≥1 year) and after patients with interstitial lung disease, those with cancer, and those on glucocorticoids prior to COVID-19 diagnosis were excluded.
Conclusion: Patients who received anti-CD20 monoclonal antibodies for immune-mediated diseases prior to COVID-19 had higher mortality following COVID-19 than matched comparators, highlighting the urgent need to mitigate excess risks in recipients of anti-CD20 monoclonal antibodies during the ongoing pandemic.
