Rituximab Should Be 'Prescribed With Caution' Due To Possibl
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Rituximab was associated with more severe COVID-19 in patients with inflammatory rheumatic and musculoskeletal diseases, according to a study. Various observations suggest that the course of COVID-19 seems less favorable with rituximab than that described with other targeted treatments, with the possibility that severe forms of COVID-19 might be linked to a drug-induced defect in the antiviral humoral response.

Conversely, non-serious cases of COVID-19 in patients treated with rituximab have also been reported. Thus, it is crucial to further clarify the risk of severe COVID-19 in patients receiving rituximab, and to assess whether rituximab itself adversely affects COVID-19 outcomes or whether other confounding factors have an effect.

Researchers studied data from the French RMD COVID-19 cohort. According to the researchers, this cohort includes adult patients with inflammatory rheumatic and musculoskeletal diseases as well as confirmed, or highly suspected, COVID-19. For their study, the team analyzed data on 1,090 patients, collected between April 15 and Nov. 20, 2020. Among these patients, 63 received rituximab.

The primary endpoint was the severity of COVID-19 in patients who received rituximab, compared with those who did not. The researchers defined severe disease as requiring admission to an intensive care unit or leading to death. Secondary endpoints included examining deaths and duration of hospitalization.

According to the researchers, 13% of all included patients developed severe COVID-19 and 8% died. After adjusting for potential confounders, severe disease was more frequent, with markedly longer hospital stays, in patients who received rituximab, compared with those who did not. In addition, 21% of patients in the rituximab group died, compared with 7% in the non-rituximab group. However, the adjusted risk for death in the rituximab group was not significantly increased.

They concluded that in particular, rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases, especially if they have other comorbidities that render them particularly at risk of severe COVID-19 outcomes.