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Rituximab and COVID-19 infection in patients with autoimmune rheumatic diseases – A real-world study from India


1 Department of Rheumatology, Travancore Medical College Hospital, Kollam, Kerala; Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India; Ibn Sina Diagnostic Centre, Chittagong, Bangladesh
4 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
5 Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu; Department of General Medicine, Division of Rheumatology, Kasturba Medical College, Manipal, Karnataka, India

Correspondence Address:
John Mathew,
Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injr.injr_136_22

Introduction: Safety of rituximab (RTX) in autoimmune rheumatic diseases (AIRDs) has been a concern during this ongoing coronavirus (COVID-19) pandemic. Delayed worsening of COVID symptoms, increased hospital stays, and mortality has been reported among those infected post-RTX. This study describes the occurrence and course of COVID-19 infection among AIRD Indian patients who received RTX during this pandemic. Patients and Methods: Adult patients (≥18 years) with any AIRD, who received RTX between October 2019 and May 2021, were enrolled in this study. Patients satisfying the inclusion criteria were telephonically enquired about contracting confirmed COVID-19, its course, treatment, and outcome. Baseline parameters, immunoglobulin G level, vaccination, and comorbidity status before RTX were compared between the COVID-19 infected and noninfected patients to determine factors affecting the outcome. Results: Out of 1081 patients admitted during the study period, 218 patients received RTX. The mean age of these patients was 40.1 ± 14.2 years and comprised mostly of women (81.7%). Rheumatoid arthritis followed by lupus and anti-neutrophilic cytoplasmic antibodies-associated vasculitis was the predominant AIRD. Among the patients contacted (207/218 [94.9%]), 11 (5.3%) patients reported confirmed COVID-19 infections. Out of these, three (27.3%) had severe COVID-19 and one patient succumbed to it. Others became symptom-free after a mean duration of 14.4 ± 4.7 days of onset of symptoms. No significant difference among the baseline parameters observed predicted COVID-19 susceptibility. Conclusion: Among our AIRD patients treated with RTX, occurrence, and mortality of COVID-19 infection was low. Younger age of our patient cohort and female predominance might have contributed in reducing the severity of SARS-CoV-2 infection.


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