Rituximab and COVID-19 Outcomes in France

The administration of rituximab in patients with inflammatory rheumatic and musculoskeletal diseases is associated with more severe COVID-19 outcomes, a recent study in the journal Lancet Rheumatology has found.

Prior to this study, various observations have suggested the course of COVID-19 to be less favorable in patients with inflammatory rheumatic and musculoskeletal diseases who received rituximab compared with those who did not receive rituximab. Prof Jérôme Avouac from France and colleagues aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases in this cohort study.

For this purpose, the researchers analyzed data from the French RMD COVID-19 cohort that 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.

Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55.2 years). Of the 1090 patients, 13% developed severe COVID-19 and 8% died.

Key Findings of the Study

• After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3.26) and the duration of hospital stay was markedly longer (0.62) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group.
• 21% of 63 patients in the rituximab group died compared with 7% of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1.32).

"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 especially if they have other comorbidities that render them particularly at risk of severe COVID-19 outcomes," wrote the authors.

Reference

The study titled, "COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study," is published in the journal Lancet Rheumatology.

DOI: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(21)00059-X/fulltext