rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2021-37-46rsp-2988Research ArticleПРОБЛЕМЫ РЕВМАТОЛОГИИ В ПЕРИОД ПАНДЕМИИ КОРОНОВИРУСНОЙ БОЛЕЗНИ 2019PROBLEMS OF RHEUMATOLOGY DURING THE 2019 CORONAVIRUS PANDEMICТечение и исходы COVID-19 у пациентов с АНЦА-ассоциированными системными васкулитами, получающих лечение генно-инженерными биологическими препаратами (ритуксимаб, меполизумаб): итоги первых 8 месяцев пандемииThe course and outcomes of COVID-19 in patients with ANCA-associated systemic vasculitis, receiving biological therapy (Rituximab, Mepolizumab): The results of the first 8 months of the pandemichttps://orcid.org/0000-0003-2641-9785БекетоваТ. В.BeketovaT. V.

Бекетова Татьяна Валентиновна

115522, Москва, Каширское шоссе, 34а

Tatiana Beketova

115522, Moscow, Kashirskoye Highway, 34A

tvbek22@rambler.ruhttps://orcid.org/0000-0001-8020-2494БабакВ. В.BabakV. V.

Valeriya V. Babak

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-5285-8226СупрунМ. Д.SuprunM. D.

Marina D. Suprun

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ Научно-исследовательский институт ревматологии им В.А. НасоновойРоссияVA Nasonova Research Institute of RheumatologyRussian Federation2021020320215913746Copyright © Бекетова Т.В., Бабак В.В., Супрун М.Д., 20212021Бекетова Т.В., Бабак В.В., Супрун М.Д.Beketova T.V., Babak V.V., Suprun M.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2988

В настоящее время вопросы влияния терапии генно-инженерными биологическими препаратами на риск инфицирования и исходы COVID-19 у пациентов с АНЦА-ассоциированными системными васкулитами (АНЦА-СВ) окончательно не решены; опубликованные наблюдения немногочисленны. Накопленные в настоящее время данные свидетельствуют о возможном синергизме патологических механизмов АНЦА-СВ и COVID-19 тяжелого течения, прежде всего в контексте синдрома обструктивного тромбовоспаления сосудов микроциркуляции легких как проявления острого воспалительного синдрома при COVID-19. Случаи COVID-19 у пациентов с АНЦА-СВ, получающих анти-В-клеточную терапию ритуксимабом или лечение антагонистом интерлейкина-5 меполизумабом, требуют всестороннего анализа. По итогам первых 8 месяцев пандемии COVID-19 представлены результаты анализа течения и исходов COVID-19, основанные на наблюдении 128 пациентов с АНЦА-СВ, получающих терапию генно-инженерными биологическими препаратами в ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» (126 пациентов получали ритуксимаб, 6 – меполизумаб, в том числе 4 – после терапии ритуксимабом). Медиана возраста пациентов составила 51 (20–81) год; 61,7% – женщины. У 58 пациентов был диагностирован гранулематоз с полиангиитом (ГПА); у 38 – микроскопический полиангиит (МПА); у 24 – эозинофильный гранулематоз с полиангиитом (ЭГПА), в том числе у 54,2% из них – АНЦА-негативный вариант; у 8 пациентов – АНЦА-СВ с неопределенной нозологической принадлежностью. В период пандемии в связи с активностью или высоким риском рецидива АНЦА-СВ 47,6% (60/126) пациентам назначали ритуксимаб, в 6 случаях – меполизумаб. В первые 3 месяца пандемии частота COVID-19 у пациентов с АНЦА-СВ, получавших лечение генно-инженерными биологическими препаратами, составила 4,3% (5/115); заболевание протекало относительно благополучно, во всех случаях наступило выздоровление. Через 3–6 месяцев антитела к коронавирусу IgG сохранялись только у 1 из 4 пациентов. С сентября 2020 г. отмечен рост заболеваемости в 3 раза, при этом наблюдалось более тяжелое течение заболевания. За 8 месяцев пандемии COVID-19 диагностирован у 17,2% (22/128) пациентов; медиана возраста заболевших – 55 (25–81) лет; 54,5% – женщины. 21 из 22 пациентов получал ритуксимаб, 2/22 – меполизумаб (в том числе в 1 случае – после ритуксимаба). Частота COVID-19 была ниже при ГПА (15,5%), чем при МПА и ЭГПА (21,1 и 20,8% соответственно). Летальность составила 13,6%, включая 2 пациентов с МПА и 1 – с ГПА. При анализе выживаемости пациентов с АНЦА-СВ за последние 5 лет в группе, получавшей терапию ритуксимабом, отмечено ухудшение прогноза: в 2020 г. зарегистрированы 3 летальных исхода, обусловленных COVID-19, за 5 предшествующих лет было в общей сложности 2 летальных исхода. Среди описанных в литературе 8 случаев АНЦА-СВ с COVID-19 на фоне лечения ритуксимабом обобщенная летальность составила 12,5%. Обсуждаются опубликованные сведения о применении ритуксимаба в период пандемии COVID-19 и вопросы влияния В-клеток и их деплеции на течение и исходы COVID-19. По-видимому, анти-В-клеточная терапия, не снижая риск инфицирования, способна оказывать протективный эффект в отношении тяжелого/катастрофического течения COVID-19, что тем не менее может оказаться недостаточным у пациентов с АНЦА-СВ в активной стадии заболевания на фоне полиорганного поражения. Среди пациентов с ЭГПА и COVID-19 во всех случаях наступило выздоровление. Обсуждаются немногочисленные данные литературы, свидетельствующие о снижении тяжести течения COVID-19 у пациентов с бронхиальной астмой в результате лечения меполизумабом. Исключительно важным является дальнейший анализ случаев COVID-19 у пациентов с АНЦА-СВ и другими иммуновоспалительными ревматическими заболеваниями, получающих лечение генно-инженерными биологическими препаратами.

Objective

Objective. Currently, the issues of the effect of anti-B cell therapy or inhibitor of interleukin 5 on the risk of COVID-19 infecting and outcomes in patients with ANCA-associated vasculitis (AAV) has not been completely studied. We present an analysis of the COVID-19 course and outcomes in AAV patients treated with rituximab or mepolizumab from one rheumatology center registry.

Methods

Methods. From November 11 to November 15, 2020, a cross-sectional study was conducted using telephone and online surveys, and information was collected from all 128 AAV patients treated with rituximab in V.A. Nasonova Research Institute of Rheumatology. Patients mean age was 51 (20–81) years, 61.7% were women. Granulomatosis with polyangiitis (GPA) was diagnosed in 58 patients, microscopic polyangiitis (MPA) – in 38, eosinophilic granulomatosis with polyangiitis (EGPA) – in 24 (including 54.2% of ANCA-negative cases), and AAV with uncertain nosological affiliation – in 8 patients. Due to the disease activity or a high risk of AAV recurrence during the pandemic rituximab was prescribed in 60/126 (47.6%) patients, and mepolizumab – in 6 cases.

Results

Results. In the spring of the pandemic (until May 2020), the incidence of COVID-19 in AAV patients treated with rituximab was 4.3%, the disease course was relatively favorable. All patients recovered. At month 3–6, antibodies to SARS-CoV-2 IgG persisted in only 1 out of 4 patients. Since September 2020, the incidence has increased 3-fold, with a more severe course of COVID-19. In total, in the period until November 11, 2020, COVID-19 was diagnosed in 17.2% (22/128); the mean age of patients was 55 (25–81) years; 54.5% were women. 21/22 patients were on rituximab therapy, 2 patients had mepolizumab therapy (including 1 case after previous rituximab therapy). COVID-19 incidence was lower in patients with GPA (15.5%) vs MPA and EGPA (21.1% and 20.8% respectively). The mortality rate was 13.6%, including 2 patients with MPA and 1 patient with GPA. When analyzing the 5-year survival rate according to the registry of AAV patients treated with rituximab, prognosis worsening was noted; in 2020 there were 3 deaths due to COVID-19, in the previous 5 years – only 2 deaths.

COVID-19ритуксимабмеполизумабВ-клеткиинтерлейкин-5АНЦА-ассоциированный системный васкулитгранулематоз с полиангиитоммикроскопический полиангиитэозинофильный гранулематоз с полиангиитомCOVID-19RituximabMepolizumabВ-cellsinterleukin-5ANCA-associated vasculitisgranulomatosis with polyangiitismicroscopic polyangiitiseosinophilic granulomatosis with polyangiitisРабота выполнена в рамках научной темы рег. № НИОКТР АААА-А19-119021190148-3ReferencesНасонов ЕЛ, Лила АМ, Мазуров ВИ, Белов БС, Каратеев АЕ, Дубинина ТВ и др. Коронавирусная болезнь 2019 (COVID-19) и иммуновоспалительные (аутоиммунные) ревматические заболевания. Проект рекомендаций Общероссийской общественной организации «Ассоциация ревматологов России». 2020 URL: https://rheumatolog.su/news/koronavirusnaya-bolezn-2019-COVID-19-i-immunovospalitelnye-autoimmunnye-revmaticheskie-zabolevaniya/ (accessed: 2020)Nasonov EL, Lila AM, Mazurov VI, Belov BS, Karateev AE, Dubinina TV, et al. Coronavirus disease 2019 (COVID-19) and immune inflammatory (autoimmune) rheumatic diseases. Draft recommendations of the All-Russian public organization Association of rheumatologists of Russia. 2020 (In Russ.). URL: https://rheumatolog.su/news/koronavirusnaya-bolezn-2019-COVID-19-i-immunovospalitelnye-autoimmunnye-revmaticheskie-zabolevaniya/ (accessed: 2020)Бекетова ТВ. Алгоритм диагностики системных васкулитов, ассоциированных с антинейтрофильными цитоплазматическими антителами. Терапевтический архив. 2018;5:13–21 doi: 10.26442/terarkh201890513-21Beketova TV. Diagnostic algorithm for antineutrophil cytoplasmic antibody-associated systemic vasculitis. Terapevticheskiy arkhiv = Therapeutic Archive. 2018;5:13–21 (In Russ.). doi: 10.26442/terarkh201890513-21Fornasari PM. COVID-19: Neutrophils “unfriendly fire” imbalance proteolytic cascades triggering clinical worsening and viral sepsis. Potential role explanation for convalescent plasma as “fire hose”. Preprints. 2020;2020050373. doi: 10.20944/preprints202005.0373.v1Fornasari PM. COVID-19: Neutrophils “unfriendly fire” imbalance proteolytic cascades triggering clinical worsening and viral sepsis. Potential role explanation for convalescent plasma as “fire hose”. Preprints. 2020;2020050373. doi: 10.20944/preprints202005.0373.v1Luqmani R, Suppiah R, Edwards CJ, Phillip R, Maskell J, Culliford D, et al. Mortality in Wegener’s granulomatosis: A bimodal pattern. Rheumatology (Oxford, England). 2011;50(4): 697–702. doi: 10.1093/rheumatology/keq351Luqmani R, Suppiah R, Edwards CJ, Phillip R, Maskell J, Culliford D, et al. Mortality in Wegener’s granulomatosis: A bimodal pattern. Rheumatology (Oxford, England). 2011;50(4): 697–702. doi: 10.1093/rheumatology/keq351Colling ME, Kanthi Y. COVID-19-associated coagulopathy: An exploration of mechanisms. Vascular Medicine. 2020;25(5):471– 478. doi: 10.1177/1358863X20932640Colling ME, Kanthi Y. COVID-19-associated coagulopathy: An exploration of mechanisms. Vascular Medicine. 2020;25(5):471– 478. doi: 10.1177/1358863X20932640Ciceri F, Beretta L, Scandroglio AM, Colombo S, Landoni G, Ruggeri A, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): An atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020;22(2):95–97.Ciceri F, Beretta L, Scandroglio AM, Colombo S, Landoni G, Ruggeri A, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): An atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020;22(2):95–97.Насонов ЕЛ, Бекетова ТВ, Решетняк ТМ, Лила АМ, Ананьева ЛП, Лисицина ТА и др. Коронавирусная болезнь 2019 (COVID-19) и иммуновоспалительные ревматические заболевания: на перекрестке проблем тромбовоспаления и аутоиммунитета. Научно-практическая ревматология. 2020;58(4):353–367. doi: 10.47360/1995-4484-2020-353-367Nasonov EL, Beketova TV, Reshetnyak TM, Lila AM, Ananieva LP, Lisitsyna TA, et al. Coronavirus disease 2019 (COVID-19) and immune-mediated inflammatory rheumatic diseases: At the crossroads of thromboinflammation and autoimmunity. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2020;58(4):353–367 (In Russ.). doi: 10.47360/1995-4484-2020-353-367Забозлаев ФГ, Кравченко ЭВ, Галлямова АР, Летуновский НН. Патологическая анатомия легких при новой коронавирусной инфекции (COVID-19). Предварительный анализ аутопсийных исследований. Клиническая практика. 2020;11(2):21–37. doi: 10.17816/clinpract34849Zabozlaev FG, Kravchenko EV, Gallyamova AR, Letunovsky NN. Pulmonary pathology of the new coronavirus disease (COVID-19). The preliminary analysis of post-mortem findings. Klinicheskaya praktika = Journal of Clinical Practice. 2020;11(2):21–37 (In Russ.). doi: 10.17816/clinpract34849Kronbichler A, Lee KH, Denicolò S, Choi D, Lee H, Ahn D, et al. Immunopathogenesis of ANCA-associated vasculitis. Int J Mol Sci. 2020;21(19):7319. doi: 10.3390/ijms21197319Kronbichler A, Lee KH, Denicolò S, Choi D, Lee H, Ahn D, et al. Immunopathogenesis of ANCA-associated vasculitis. Int J Mol Sci. 2020;21(19):7319. doi: 10.3390/ijms21197319Talotta R, Robertson E. Autoimmunity as the comet tail of COVID-19 pandemic. World J Clin Cases. 2020;8(17):3621– 3644. doi: 10.12998/wjcc.v8.i17.3621Talotta R, Robertson E. Autoimmunity as the comet tail of COVID-19 pandemic. World J Clin Cases. 2020;8(17):3621– 3644. doi: 10.12998/wjcc.v8.i17.3621Zhao J, Yuan Q, Wang H, Liu W, Liao X, Su Y, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis. 2020;71(16):2027–2034. doi: 10.1093/cid/ciaa344Zhao J, Yuan Q, Wang H, Liu W, Liao X, Su Y, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis. 2020;71(16):2027–2034. doi: 10.1093/cid/ciaa344Woodruff MC, Ramonell RP, Cashman KS, Nguyen DC, Saini AS, Haddad N, et al. Critically ill SARS-CoV-2 patients display lupus-like hallmarks of extrafollicular B cell activation. medRxiv. 2020.04.29.20083717; doi: 10.1101/2020.04.29.20083717Woodruff MC, Ramonell RP, Cashman KS, Nguyen DC, Saini AS, Haddad N, et al. Critically ill SARS-CoV-2 patients display lupus-like hallmarks of extrafollicular B cell activation. medRxiv. 2020.04.29.20083717; doi: 10.1101/2020.04.29.20083717Iwasaki A, Yang Y. The potential danger of suboptimal antibody responses in COVID-19. Nat Rev Immunol. 2020;20:339–341. doi: 10.1038/s41577-020-0321-6Iwasaki A, Yang Y. The potential danger of suboptimal antibody responses in COVID-19. Nat Rev Immunol. 2020;20:339–341. doi: 10.1038/s41577-020-0321-6Wang Y, Zhang L, Sang L, Ye F, Ruan S, Zhong B, et al. Kinetics of viral load and antibody response in relation to COVID-19 severity. J Clin Invest. 2020;130(10):5235–5344. doi: 10.1172/JCI138759Wang Y, Zhang L, Sang L, Ye F, Ruan S, Zhong B, et al. Kinetics of viral load and antibody response in relation to COVID-19 severity. J Clin Invest. 2020;130(10):5235–5344. doi: 10.1172/JCI138759Sun B, Feng Y, Mo X, et al. Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients. Emerg Microbes Infect. 2020;9(1):940–948. doi: 10.1080/22221751.2020.1762515Sun B, Feng Y, Mo X, et al. Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients. Emerg Microbes Infect. 2020;9(1):940–948. doi: 10.1080/22221751.2020.1762515Bastard P, Rosen LB, Zhang Q, Michailidis E, Hoffmann HH, Zhang Y, et al. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science. 2020;370(6515):eabd4585. doi: 10.1126/science.abd4585Bastard P, Rosen LB, Zhang Q, Michailidis E, Hoffmann HH, Zhang Y, et al. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science. 2020;370(6515):eabd4585. doi: 10.1126/science.abd4585Song WC, FitzGerald GA. COVID-19, microangiopathy, hemostatic activation, and complement. J Clin Invest. 2020;130(8): 3950–3953. doi: 10.1172/JCI140183Song WC, FitzGerald GA. COVID-19, microangiopathy, hemostatic activation, and complement. J Clin Invest. 2020;130(8): 3950–3953. doi: 10.1172/JCI140183Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020;(220):1–13. doi: 10.1016/j.trsl.2020.04.007Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020;(220):1–13. doi: 10.1016/j.trsl.2020.04.007Zhou Z, Ren L, Zhang L, Zhong J, Xiao Y, Jia Z, et al. Heightened Innate immune responses in the respiratory tract of COVID-19 patients. Cell Host Microbe. 2020;27:883–890.e2 doi: 10.1016/j.chom.2020.04.017Zhou Z, Ren L, Zhang L, Zhong J, Xiao Y, Jia Z, et al. Heightened Innate immune responses in the respiratory tract of COVID-19 patients. Cell Host Microbe. 2020;27:883–890.e2 doi: 10.1016/j.chom.2020.04.017Singh A, Sood N, Narang V, Goyal A. Morphology of COVID-19-affected cells in peripheral blood film. BMJ Case Rep. 2020;13(5):e236117. doi: 10.1136/bcr-2020-236117Singh A, Sood N, Narang V, Goyal A. Morphology of COVID-19-affected cells in peripheral blood film. BMJ Case Rep. 2020;13(5):e236117. doi: 10.1136/bcr-2020-236117Zheng M, Gao Y, Wang G, Song G, Liu S, Sun D, et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol. 2020;17(5):533–535. doi: 10.1038/s41423-020-0402-2Zheng M, Gao Y, Wang G, Song G, Liu S, Sun D, et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients. Cell Mol Immunol. 2020;17(5):533–535. doi: 10.1038/s41423-020-0402-2Cao X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol 2020;20:269–270. doi: 10.1038/S41577-020-0308-3Cao X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol 2020;20:269–270. doi: 10.1038/S41577-020-0308-3Sachdeva M, Gianotti R, Shah M, Bradanini L, Tosi D, Veraldi S, et al. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci. 2020;98:75–81. doi: 10.1016/j.jdermsci.2020.04.011Sachdeva M, Gianotti R, Shah M, Bradanini L, Tosi D, Veraldi S, et al. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci. 2020;98:75–81. doi: 10.1016/j.jdermsci.2020.04.011Conde Cardona G, Quintana Pájaro LD, Quintero Marzola ID, Ramos Villegas Y, Moscote Salazar LR. Neurotropism of SARS-CoV-2: Mechanisms and manifestations. J Neurol Sci. 2020;412:116824. doi: 10.1016/j.jns.2020.116824Conde Cardona G, Quintana Pájaro LD, Quintero Marzola ID, Ramos Villegas Y, Moscote Salazar LR. Neurotropism of SARS-CoV-2: Mechanisms and manifestations. J Neurol Sci. 2020;412:116824. doi: 10.1016/j.jns.2020.116824Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: Causality or coincidence? Lancet Neurol. 2020;19:383–384. doi: 10.1016/S1474-4422(20)30109-5Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: Causality or coincidence? Lancet Neurol. 2020;19:383–384. doi: 10.1016/S1474-4422(20)30109-5Lazarian G, Quinquenel A, Bellal M, Siavellis J, Jacquy C, Re D, et al. Autoimmune haemolytic anaemia associated with COVID-19 infection. Br J Haematol. 2020;190:29–31. doi: 10.1111/bjh.16794Lazarian G, Quinquenel A, Bellal M, Siavellis J, Jacquy C, Re D, et al. Autoimmune haemolytic anaemia associated with COVID-19 infection. Br J Haematol. 2020;190:29–31. doi: 10.1111/bjh.16794Zulfiqar AA, Lorenzo-Villalba N, Hassler P, Andrès E. Immune thrombocytopenic purpura in a patient with Covid-19. N Engl J Med. 2020;382:e43. doi: 10.1056/NEJMc2010472Zulfiqar AA, Lorenzo-Villalba N, Hassler P, Andrès E. Immune thrombocytopenic purpura in a patient with Covid-19. N Engl J Med. 2020;382:e43. doi: 10.1056/NEJMc2010472Beydon M, Chevalier K, Al Tabaa O, Hamroun S, Delettre AS, Thomas M, et al. Myositis as a manifestation of SARS-CoV-2. Ann Rheum Dis. Published Online First. 2020. doi: 10.1136/annrheumdis-2020-217573Beydon M, Chevalier K, Al Tabaa O, Hamroun S, Delettre AS, Thomas M, et al. Myositis as a manifestation of SARS-CoV-2. Ann Rheum Dis. Published Online First. 2020. doi: 10.1136/annrheumdis-2020-217573Craver R, Huber S, Sandomirsky M, McKenna D, Schieffelin J, Finger L. Fatal eosinophilic myocarditis in a healthy 17-year-old male with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2c). Fetal Pediatr Pathol. 2020;39:263–268. doi: 10.1080/1551 3815.2020.1761491Craver R, Huber S, Sandomirsky M, McKenna D, Schieffelin J, Finger L. Fatal eosinophilic myocarditis in a healthy 17-year-old male with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2c). Fetal Pediatr Pathol. 2020;39:263–268. doi: 10.1080/1551 3815.2020.1761491Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escalada-Pellitero S, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. 2020;37:406–411. doi: 10.1111/pde.14215Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escalada-Pellitero S, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. 2020;37:406–411. doi: 10.1111/pde.14215Licciardi F, Pruccoli G, Denina M, Parodi E, Taglietto M, Rosati S, et al. SARS-CoV-2-induced Kawasaki-like hyperinflammatory syndrome: A novel COVID phenotype in children. Pediatrics. 2020;146:e20201711. doi: 10.1542/peds.2020-1711Licciardi F, Pruccoli G, Denina M, Parodi E, Taglietto M, Rosati S, et al. SARS-CoV-2-induced Kawasaki-like hyperinflammatory syndrome: A novel COVID phenotype in children. Pediatrics. 2020;146:e20201711. doi: 10.1542/peds.2020-1711Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: An observational cohort study. Lancet. 2020;395:1771–1778. doi: 10.1016/S0140-6736(20)31103-XVerdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: An observational cohort study. Lancet. 2020;395:1771–1778. doi: 10.1016/S0140-6736(20)31103-XGaleotti C, Bayry J. Autoimmune and inflammatory diseases following COVID-19. Nat Rev Rheumatol. 2020;16(8):413–414. doi: 10.1038/s41584-020-0448-7Galeotti C, Bayry J. Autoimmune and inflammatory diseases following COVID-19. Nat Rev Rheumatol. 2020;16(8):413–414. doi: 10.1038/s41584-020-0448-7Letellier A, Gibelin A, Voiriot G, Fartoukh M, Djibré M. Destructive pulmonary fibrosis after severe COVID-19 pneumonia. Int J Infect Dis. 2020;100:377–378. doi: 10.1016/j.ijid.2020.09.026Letellier A, Gibelin A, Voiriot G, Fartoukh M, Djibré M. Destructive pulmonary fibrosis after severe COVID-19 pneumonia. Int J Infect Dis. 2020;100:377–378. doi: 10.1016/j.ijid.2020.09.026Zhang W, Zhao Y, Zhang F, Wang Q, Li T, Liu Z, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The perspectives of clinical immunologists from China. Clin Immunol. 2020;214:108393. doi: 10.1016/j.clim.2020.108393Zhang W, Zhao Y, Zhang F, Wang Q, Li T, Liu Z, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The perspectives of clinical immunologists from China. Clin Immunol. 2020;214:108393. doi: 10.1016/j.clim.2020.108393Guisado-Vasco P, Valderas-Ortega S, Carralón-González MM, Roda-Santacruz A, González-Cortijo L, Sotres-Fernández G, et al. Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective observational study (COQUIMA cohort). EClinicalMedicine. 2020;28:100591. doi: 10.1016/j.eclinm.2020.100591Guisado-Vasco P, Valderas-Ortega S, Carralón-González MM, Roda-Santacruz A, González-Cortijo L, Sotres-Fernández G, et al. Clinical characteristics and outcomes among hospitalized adults with severe COVID-19 admitted to a tertiary medical center and receiving antiviral, antimalarials, glucocorticoids, or immunomodulation with tocilizumab or cyclosporine: A retrospective observational study (COQUIMA cohort). EClinicalMedicine. 2020;28:100591. doi: 10.1016/j.eclinm.2020.100591Diurno F, Numis FG, Porta G, Cirillo F, Maddaluno S, Ragozzino A, et al. Eculizumab treatment in patients with COVID-19: Preliminary results from real life ASL Napoli 2 Nord experience. Eur Rev Med Pharmacol Sci. 2020;24(7):4040–4047. doi: 10.26355/eurrev_202004_20875Diurno F, Numis FG, Porta G, Cirillo F, Maddaluno S, Ragozzino A, et al. Eculizumab treatment in patients with COVID-19: Preliminary results from real life ASL Napoli 2 Nord experience. Eur Rev Med Pharmacol Sci. 2020;24(7):4040–4047. doi: 10.26355/eurrev_202004_20875Насонов ЕЛ, Бекетова ТВ, Ананьева ЛП, Васильев ВИ, Соловьев СК, Авдеева АС. Перспективы анти-В-клеточной терапии при иммуновоспалительных ревматических заболеваниях. Научно-практическая ревматология. 2019;57(Прил. 1): 3–40. doi: 10.14412/1995-4484-2019-3-40Nasonov EL, Beketova TV, Ananyeva LP, Vasilyev VI, Solovyev SK, Avdeeva AS. Prospects for anti-B-cell therapy in immuno-inflammatory rheumatic diseases. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2019;57:1–40 (In Russ.). doi: 10.14412/1995-4484-2019-3-40Izquierdo JL, Almonacid C, González Y, Del Rio-Bermúdez C, Ancochea J, Cárdenas R, et al. The impact of COVID-19 on patients with asthma. Eur Respir J. Published online ahead of print. 2020 Dec 17;2003142. doi: 10.1183/13993003.03142-2020Izquierdo JL, Almonacid C, González Y, Del Rio-Bermúdez C, Ancochea J, Cárdenas R, et al. The impact of COVID-19 on patients with asthma. Eur Respir J. Published online ahead of print. 2020 Dec 17;2003142. doi: 10.1183/13993003.03142-2020Matucci A, Caminati M, Vivarelli E, Vianello A, Micheletto C, Menzella F, et al. COVID-19 in severe asthmatic patients during ongoing treatment with biologicals targeting type 2 inflammation: Results from a multicenter Italian survey. Allergy. 2020. doi: 10.1111/all.14516Matucci A, Caminati M, Vivarelli E, Vianello A, Micheletto C, Menzella F, et al. COVID-19 in severe asthmatic patients during ongoing treatment with biologicals targeting type 2 inflammation: Results from a multicenter Italian survey. Allergy. 2020. doi: 10.1111/all.14516Banerjee S, George M, Young K, Venkatachalam S, Gordon J, Burroughs C, et al. Effects of the COVID-19 pandemic on patients living with vasculitis. ACR Open Rheumatology. 2020:1–8. doi: 10.1002/acr2.11204Banerjee S, George M, Young K, Venkatachalam S, Gordon J, Burroughs C, et al. Effects of the COVID-19 pandemic on patients living with vasculitis. ACR Open Rheumatology. 2020:1–8. doi: 10.1002/acr2.11204Kant S, Morris A, Ravi S, Floyd L, Gapud E, Antichos B, et al. The impact of COVID-19 pandemic on patients with ANCA associated vasculitis. J Nephrol. 2020 Oct 8:1–6. doi: 10.1007/s40620-020-00881-3Kant S, Morris A, Ravi S, Floyd L, Gapud E, Antichos B, et al. The impact of COVID-19 pandemic on patients with ANCA associated vasculitis. J Nephrol. 2020 Oct 8:1–6. doi: 10.1007/s40620-020-00881-3Liu L, Wei Q, Lin Q, Fang J, Wang H, Kwok H, et al. Anti-spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARS-CoV infection. JCI Insight. 2019;4:e123158. doi: 10.1172/jci.insight.123158Liu L, Wei Q, Lin Q, Fang J, Wang H, Kwok H, et al. Anti-spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARS-CoV infection. JCI Insight. 2019;4:e123158. doi: 10.1172/jci.insight.123158Zuo Y, Yalavarthi S, Shi H, Gockman K, Zuo M, Madison JA, et al. Neutrophil extracellular traps (NETs) as markers of disease severity in COVID-19. medRxiv. 2020:2020.04.09.20059626. doi: 10.1101/2020.04.09.20059626Zuo Y, Yalavarthi S, Shi H, Gockman K, Zuo M, Madison JA, et al. Neutrophil extracellular traps (NETs) as markers of disease severity in COVID-19. medRxiv. 2020:2020.04.09.20059626. doi: 10.1101/2020.04.09.20059626Vojdani A, Kharrazian D. Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clin Immunol. 2020;217:108480. doi: 10.1016/j.clim.2020.108480Vojdani A, Kharrazian D. Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clin Immunol. 2020;217:108480. doi: 10.1016/j.clim.2020.108480Quinti I, Lougaris V, Cinzia Milito C, Cinetto F, Pecoraro A, Mezzaroma I, et al. A possible role for B cells in COVID-19? Lesson from patients with agammaglobulinemia. J All Clin Immunol. 2020;146(1):211–213.e4. doi: 10.1016/j.jaci.2020.04.013Quinti I, Lougaris V, Cinzia Milito C, Cinetto F, Pecoraro A, Mezzaroma I, et al. A possible role for B cells in COVID-19? Lesson from patients with agammaglobulinemia. J All Clin Immunol. 2020;146(1):211–213.e4. doi: 10.1016/j.jaci.2020.04.013Soresina A, Moratto D, Chiarini M, Paolillo C, Baresi G, Focà E, et al. Two X-linked agammaglobulinemia patients develop pneumonia as COVID-19 manifestation but recover. Pediatr Allergy Immunol. 2020;31(5):565–569. doi: 10.1111/pai.13263Soresina A, Moratto D, Chiarini M, Paolillo C, Baresi G, Focà E, et al. Two X-linked agammaglobulinemia patients develop pneumonia as COVID-19 manifestation but recover. Pediatr Allergy Immunol. 2020;31(5):565–569. doi: 10.1111/pai.13263Fill L, Hadney L, Graven K, Persaud R, Hostoffer R. The clinical observation of a patient with common variable immunodeficiency diagnosed as having coronavirus disease 2019. Ann Allergy Asthma Immunol. 2020;125(1):112–114. doi: 10.1016/j.anai.2020.04.033Fill L, Hadney L, Graven K, Persaud R, Hostoffer R. The clinical observation of a patient with common variable immunodeficiency diagnosed as having coronavirus disease 2019. Ann Allergy Asthma Immunol. 2020;125(1):112–114. doi: 10.1016/j.anai.2020.04.033Montero-Escribano P, Matías-Guiu J, Gómez-Iglesias P, Porta-Etessam J, Pytel V, Matias-Guiu JA. Anti-CD20 and Covid-19 in multiple sclerosis and related disorders: A case series of 60 patients from Madrid, Spain. Mult Scler Relat Disord. 2020;42:102185. doi: 10.1016/j.msard.2020.102185Montero-Escribano P, Matías-Guiu J, Gómez-Iglesias P, Porta-Etessam J, Pytel V, Matias-Guiu JA. Anti-CD20 and Covid-19 in multiple sclerosis and related disorders: A case series of 60 patients from Madrid, Spain. Mult Scler Relat Disord. 2020;42:102185. doi: 10.1016/j.msard.2020.102185Safavi F, Nourbakhsh B, Azimi AR. B-cell depleting therapies may affect susceptibility to acute respiratory illness among patients with multiple sclerosis during the early COVID-19 epidemic in Iran. Mult Scler Relat Disord. 2020;43:102195. doi: 10.1016/j.msard.2020.102195Safavi F, Nourbakhsh B, Azimi AR. B-cell depleting therapies may affect susceptibility to acute respiratory illness among patients with multiple sclerosis during the early COVID-19 epidemic in Iran. Mult Scler Relat Disord. 2020;43:102195. doi: 10.1016/j.msard.2020.102195Schramm MA, Venhoff N, Wagner D, Thiel J, Huzly D, Craig-Mueller N, et al. COVID-19 in a severely immunosuppressed patient with life-threatening eosinophilic granulomatosis with polyangiitis. Front Immunol. 2020;11:2086. doi: 10.3389/fimmu.2020.02086Schramm MA, Venhoff N, Wagner D, Thiel J, Huzly D, Craig-Mueller N, et al. COVID-19 in a severely immunosuppressed patient with life-threatening eosinophilic granulomatosis with polyangiitis. Front Immunol. 2020;11:2086. doi: 10.3389/fimmu.2020.02086Suárez-Díaz S, Morán-Castaño C, Coto-Hernández R, et al. Mild COVID-19 in ANCA-associated vasculitis treated with rituximab. Ann Rheum Dis. Published Online First. 2020 Aug 7 doi: 10.1136/annrheumdis-2020-218246Suárez-Díaz S, Morán-Castaño C, Coto-Hernández R, et al. Mild COVID-19 in ANCA-associated vasculitis treated with rituximab. Ann Rheum Dis. Published Online First. 2020 Aug 7 doi: 10.1136/annrheumdis-2020-218246Fallet B, Kyburz D, Walker UA. Mild course of Coronavirus disease 2019 and spontaneous severe acute respiratory syndrome coronavirus 2 clearance in a patient with depleted peripheral blood B-cells due to treatment with rituximab. Arthritis Rheumatol. 2020;72:1581–1582. doi: 10.1002/art.41380Fallet B, Kyburz D, Walker UA. Mild course of Coronavirus disease 2019 and spontaneous severe acute respiratory syndrome coronavirus 2 clearance in a patient with depleted peripheral blood B-cells due to treatment with rituximab. Arthritis Rheumatol. 2020;72:1581–1582. doi: 10.1002/art.41380Guilpain P, Le Bihan C, Foulongne V, Taourel P, Pansu N, Thibault A, et al. Rituximab for granulomatosis with polyangiitis in the pandemic of COVID-19: Lessons from a case with severe pneumonia. Ann Rheum Dis. 2021;80:e10. doi: 10.1136/annrheumdis-2020-217549Guilpain P, Le Bihan C, Foulongne V, Taourel P, Pansu N, Thibault A, et al. Rituximab for granulomatosis with polyangiitis in the pandemic of COVID-19: Lessons from a case with severe pneumonia. Ann Rheum Dis. 2021;80:e10. doi: 10.1136/annrheumdis-2020-217549Loarce-Martos J, García-Fernández A, López-Gutiérrez F, García-García V, Calvo-Sanz L, del Bosque-Granero I, et al. High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: A descriptive study. Rheumatol Int. 2020;40(12):2015–2021. doi: 10.1007/s00296-020-04699-xLoarce-Martos J, García-Fernández A, López-Gutiérrez F, García-García V, Calvo-Sanz L, del Bosque-Granero I, et al. High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: A descriptive study. Rheumatol Int. 2020;40(12):2015–2021. doi: 10.1007/s00296-020-04699-xFavalli EG, Agape E, Caporali R. Incidence and clinical course of COVID-19 in patients with connective tissue diseases: A descriptive observational analysis. J Rheumatol. 2020;47:1296. doi: 10.3899/jrheum.200507Favalli EG, Agape E, Caporali R. Incidence and clinical course of COVID-19 in patients with connective tissue diseases: A descriptive observational analysis. J Rheumatol. 2020;47:1296. doi: 10.3899/jrheum.200507

The authors declare that there are no conflicts of interest present.