COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated [...]

Avouac, J., Drumez, E., Hachulla, E., Seror, R., Georgin-Lavialle, S., El Mahou, S., et al. (2021).


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Background : Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases.


Methods : In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609.


Interpretation : Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases.


Acknowledgments : This study was not supported by research funding, but FAI2R is funded by the French Ministry of Social Affairs and Health. Muriel Herasse (Filière des maladies Auto-Immunes et Autoinflammatoires Rares [FAI2 R], CHU de Lyon, Lyon, France) had a major role in collecting the missing data of the cohort. We thank Julien Labreuche (biostatistician at CHU Lille, Lille, France) for the help in the statistical analysis. We thank the pro-bono support of SANOÏA Digital Contact Research Organization (Aubagne, France) team, who provided outstanding electronic case report forms, agile data visualisation, and extensive project support.


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  • (publication) Avouac, J., Drumez, E., Hachulla, E., Seror, R., Georgin-Lavialle, S., El Mahou, S., et al. (2021). COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study - The Lancet Rheumatology.

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