Fagni Filippo, Simon David, Tascilar Koray, Schoenau Verena, Sticherling Michael, Neurath Markus F, Schett Georg
Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany.
Deutsches Zentrum Immuntherapie, Friedrich-Alexander University Erlangen-Nuermberg, Erlangen, Germany.
Lancet Rheumatol. 2021 Oct;3(10):e724-e736. doi: 10.1016/S2665-9913(21)00247-2. Epub 2021 Aug 27.
At the beginning of the COVID-19 pandemic, patients with immune-mediated inflammatory diseases were considered to be at high risk for SARS-CoV-2 infection and the development of severe COVID-19. Data collected over the past year, however, suggest that a diagnosis of inflammatory arthritis, psoriasis, or inflammatory bowel diseases does not increase risk for SARS-CoV-2 infection or severe COVID-19 compared with people without these diseases. Furthermore, substantial data suggest that certain medications frequently used in patients with immune-mediated inflammatory diseases, in particular cytokine inhibitors, might even lower the risk for severe COVID-19. Conversely, glucocorticoids and potentially B-cell-depleting treatments seem to worsen COVID-19 outcomes. Additionally, the first data on SARS-CoV-2 vaccination in patients with these diseases suggest that tolerability of vaccination in patients with immune-mediated inflammatory diseases is good, although the immune response to vaccination can be somewhat reduced in this patient group, particularly those taking methotrexate or CD20-targeted treatment.
在新冠疫情初期，免疫介导的炎症性疾病患者被认为感染新冠病毒以及发展为重症新冠的风险很高。然而，过去一年收集的数据表明，与没有这些疾病的人相比，诊断为炎性关节炎、银屑病或炎性肠病并不会增加感染新冠病毒或患重症新冠的风险。此外，大量数据表明，免疫介导的炎症性疾病患者常用的某些药物，尤其是细胞因子抑制剂，甚至可能降低患重症新冠的风险。相反，糖皮质激素以及可能的B细胞清除疗法似乎会使新冠病情恶化。此外，有关这些疾病患者接种新冠疫苗的首批数据表明，免疫介导的炎症性疾病患者对疫苗的耐受性良好，尽管该患者群体对疫苗的免疫反应可能会有所降低，尤其是那些正在服用甲氨蝶呤或接受CD20靶向治疗的患者。
