Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience
Thamer S Alhowaish,1,2 Moustafa S Alhamadh,2,3 Alaa Mathkour,4 Marwan Alamoudi,2,5 Hossam Ali Alqahtani,1,2 Abdulrahman Alrashid2,3,5 1Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; 2King Abdullah International Medi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-08-01
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| Series: | Open Access Rheumatology: Research and Reviews |
| Subjects: | |
| Online Access: | https://www.dovepress.com/clinical-course-and-outcomes-of-covid-19-infection-in-patients-treated-peer-reviewed-fulltext-article-OARRR |
| _version_ | 1797733395640352768 |
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| author | Alhowaish TS Alhamadh MS Mathkour A Alamoudi M Alqahtani HA Alrashid A |
| author_facet | Alhowaish TS Alhamadh MS Mathkour A Alamoudi M Alqahtani HA Alrashid A |
| author_sort | Alhowaish TS |
| collection | DOAJ |
| description | Thamer S Alhowaish,1,2 Moustafa S Alhamadh,2,3 Alaa Mathkour,4 Marwan Alamoudi,2,5 Hossam Ali Alqahtani,1,2 Abdulrahman Alrashid2,3,5 1Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; 2King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia; 3College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAUHS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia; 4Ministry of Health, Riyadh, 12613, Kingdom of Saudi Arabia; 5Department of Medicine, Division of Rheumatology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Thamer S Alhowaish, Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia, Email Thamersa18@gmail.comIntroduction: Patients receiving rituximab (RTX) may be at increased risk for severe Coronavirus infections and worse outcomes compared with the general population. Because of the conflicting results concerning the effect of RTX on the clinical course and outcomes of COVID-19 infection, we aimed to share our experience with 35 patients infected with COVID-19 while treated with RTX for a variety of clinical indications.Methods: This was a single-centre retrospective cohort study that included 35 patients. All patients aged ≥ 14 years who were treated with RTX for various conditions and were found to have COVID-19 infection were included. Patients with poor outcomes or patients with suspected COVID-19 infection were excluded.Results: The patients’ mean age was 42.8 ± 16.3 years with an average BMI of 29.9 ± 11.4 kg/m2. Over half (51.4%, n = 18) of the patients received RTX at a dose of 375 mg/m2 with a median frequency of 4 doses. More than a third (37.1%, n = 13) of the patients had hypogammaglobulinemia and 25.7% had low CD19. Over a third (42.9%, n= 15) of the patients required hospitalization and almost a third (25.7%, n = 9) required treatment in the intensive care unit. There was a statistically significant association between intensive care unit admission and age, steroid use, and low CD19. The mortality rate was 25.7%, and it was significantly higher in elderly, diabetics, corticosteroid users, patients who were hospitalized, treated in the intensive care unit, and had low immunoglobin or CD19.Conclusion: Treatment with RTX seems to be a potential risk factor for unfavorable outcomes in COVID-19 patients. RTX should be used with caution or avoided unless the benefit clearly outweighs the risk.Keywords: rituximab, SARS-CoV-2, COVID-19, autoimmunity, hypogammaglobulinemia, rheumatology |
| first_indexed | 2024-03-12T12:27:32Z |
| format | Article |
| id | doaj.art-2a5de10fda524fdfb44d82ad8f9ade7b |
| institution | Directory Open Access Journal |
| issn | 1179-156X |
| language | English |
| last_indexed | 2024-03-12T12:27:32Z |
| publishDate | 2023-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Open Access Rheumatology: Research and Reviews |
| spelling | doaj.art-2a5de10fda524fdfb44d82ad8f9ade7b2023-08-29T19:31:00ZengDove Medical PressOpen Access Rheumatology: Research and Reviews1179-156X2023-08-01Volume 1514515986251Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center ExperienceAlhowaish TSAlhamadh MSMathkour AAlamoudi MAlqahtani HAAlrashid AThamer S Alhowaish,1,2 Moustafa S Alhamadh,2,3 Alaa Mathkour,4 Marwan Alamoudi,2,5 Hossam Ali Alqahtani,1,2 Abdulrahman Alrashid2,3,5 1Division of Neurology, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; 2King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia; 3College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAUHS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia; 4Ministry of Health, Riyadh, 12613, Kingdom of Saudi Arabia; 5Department of Medicine, Division of Rheumatology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Thamer S Alhowaish, Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia, Email Thamersa18@gmail.comIntroduction: Patients receiving rituximab (RTX) may be at increased risk for severe Coronavirus infections and worse outcomes compared with the general population. Because of the conflicting results concerning the effect of RTX on the clinical course and outcomes of COVID-19 infection, we aimed to share our experience with 35 patients infected with COVID-19 while treated with RTX for a variety of clinical indications.Methods: This was a single-centre retrospective cohort study that included 35 patients. All patients aged ≥ 14 years who were treated with RTX for various conditions and were found to have COVID-19 infection were included. Patients with poor outcomes or patients with suspected COVID-19 infection were excluded.Results: The patients’ mean age was 42.8 ± 16.3 years with an average BMI of 29.9 ± 11.4 kg/m2. Over half (51.4%, n = 18) of the patients received RTX at a dose of 375 mg/m2 with a median frequency of 4 doses. More than a third (37.1%, n = 13) of the patients had hypogammaglobulinemia and 25.7% had low CD19. Over a third (42.9%, n= 15) of the patients required hospitalization and almost a third (25.7%, n = 9) required treatment in the intensive care unit. There was a statistically significant association between intensive care unit admission and age, steroid use, and low CD19. The mortality rate was 25.7%, and it was significantly higher in elderly, diabetics, corticosteroid users, patients who were hospitalized, treated in the intensive care unit, and had low immunoglobin or CD19.Conclusion: Treatment with RTX seems to be a potential risk factor for unfavorable outcomes in COVID-19 patients. RTX should be used with caution or avoided unless the benefit clearly outweighs the risk.Keywords: rituximab, SARS-CoV-2, COVID-19, autoimmunity, hypogammaglobulinemia, rheumatologyhttps://www.dovepress.com/clinical-course-and-outcomes-of-covid-19-infection-in-patients-treated-peer-reviewed-fulltext-article-OARRRrituximabsars-cov-2covid-19autoimmunityhypogammaglobulinemiarheumatology |
| spellingShingle | Alhowaish TS Alhamadh MS Mathkour A Alamoudi M Alqahtani HA Alrashid A Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience Open Access Rheumatology: Research and Reviews rituximab sars-cov-2 covid-19 autoimmunity hypogammaglobulinemia rheumatology |
| title | Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience |
| title_full | Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience |
| title_fullStr | Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience |
| title_full_unstemmed | Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience |
| title_short | Clinical Course and Outcomes of COVID-19 Infection in Patients Treated with Rituximab: A Tertiary Care Center Experience |
| title_sort | clinical course and outcomes of covid 19 infection in patients treated with rituximab a tertiary care center experience |
| topic | rituximab sars-cov-2 covid-19 autoimmunity hypogammaglobulinemia rheumatology |
| url | https://www.dovepress.com/clinical-course-and-outcomes-of-covid-19-infection-in-patients-treated-peer-reviewed-fulltext-article-OARRR |
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