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  • Antirheumatic drugs, B cell depletion and critical COVID-19: correspondence on ‘Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine’ by Math…

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Correspondence
Antirheumatic drugs, B cell depletion and critical COVID-19: correspondence on ‘Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine’ by Mathian et al
  1. Quirin Notz1,
  2. Patrick Meybohm1,
  3. Peter Kranke1,
  4. Dirk Weismann2,
  5. Christopher Lotz1,
  6. Marc Schmalzing3
  1. 1 Department of Anesthesiology and Critical Care, Universitätsklinikum Würzburg, Würzburg, Germany
  2. 2 Department of Internal Medicine I, Critical Care, Universitätsklinikum Würzburg, Würzburg, Germany
  3. 3 Department of Internal Medicine II, Rheumatology, Universitätsklinikum Würzburg, Würzburg, Germany
  1. Correspondence to Dr Quirin Notz, Department of Anesthesiology and Critical Care, Universitätsklinikum Würzburg, Würzburg 97080, Germany; Notz_Q{at}ukw.de

https://doi.org/10.1136/annrheumdis-2020-218778

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    In a recent case series, Mathian et al reported on 17 patients suffering from systemic lupus erythematosus and COVID-19.1 All of these patients received long-term hydroxychloroquine treatment and initial signs and symptoms of COVID-19 were similar to those previously described. However, as 50% of the patients remained hospitalised at the time of publication, the authors cannot comment on the duration and eventual outcome of COVID-19 in all of their patients. Furthermore, it is emerging that hydroxychloroquine does not alter COVID-19.2–4 As such, we actually believe that other immunosuppressive, antirheumatic medications require more attention. Mathian et al rightfully pointed out that besides long-term hydroxychloroquine treatment, steroids and other baseline immunosuppressant drugs are often present in patients with rheumatic diseases. In this context, we found an altered immune response and noticeable prolongation of COVID-19 from the onset of symptoms to intensive care unit (ICU) admission in two patients pretreated with rituximab (RTX) (table 1).

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    Table 1

    Clinical course

    Patient A (aged 40–60 years) suffered from rheumatoid arthritis, treated with daily doses of leflunomide and low-dose prednisolone. RTX was administered every 6 months. The patient was admitted to ICU 33 days after the onset of COVID-19 symptoms with severe acute …

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    Footnotes

    • Contributors QN, CL and MS conceptualised the work, collected the data, wrote and revised the manuscript. QN has prepared the figure. PM, PK and DW revised the manuscript and provided resources.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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