Venkat Rathnam, Wallace Zachary S, Sparks Jeffrey A
Tufts University School of Medicine, Boston, MA, USA.
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA.
Curr Rheumatol Rep. 2023 Nov;25(11):236-245. doi: 10.1007/s11926-023-01111-y. Epub 2023 Aug 19.
To review the impact of disease-modifying antirheumatic drugs (DMARDs) on COVID-19 severity and vaccine immunogenicity and to discuss COVID-19 outcomes in patients with rheumatoid arthritis (RA).
Rituximab is associated with severe COVID-19 and impaired vaccine immunogenicity via its B cell-depleting mechanism. JAK inhibitors and glucocorticoids have been modestly associated with severe COVID-19 and impaired vaccine immunogenicity. TNF inhibitors may have a protective effect against severe COVID-19 and do not appear to affect vaccine immunogenicity. Clinical trials have shown improved seroconversion and antibody titers when methotrexate is held around vaccine doses, but this may yield increased risk of RA flare. Patients with RA are also impacted by DMARD disruption, RA flares, and post-acute sequelae of COVID-19 after COVID-19 infection. Given the risks of COVID-19, rituximab should be used with caution in RA. Holding methotrexate doses around COVID-19 vaccination improves immunogenicity but may increase RA flare risk.
回顾改善病情抗风湿药（DMARDs）对新冠病毒疾病（COVID-19）严重程度和疫苗免疫原性的影响，并讨论类风湿关节炎（RA）患者的COVID-19转归情况。
利妥昔单抗通过其耗竭B细胞的机制与严重的COVID-19及受损的疫苗免疫原性相关。Janus激酶（JAK）抑制剂和糖皮质激素与严重的COVID-19及受损的疫苗免疫原性有一定关联。肿瘤坏死因子（TNF）抑制剂可能对严重的COVID-19有保护作用，且似乎不影响疫苗免疫原性。临床试验表明，在疫苗接种前后停用甲氨蝶呤时，血清转化和抗体滴度有所改善，但这可能会增加类风湿关节炎病情复发的风险。类风湿关节炎患者还会受到DMARD中断、类风湿关节炎病情复发以及COVID-19感染后急性后遗症的影响。鉴于COVID-19的风险，利妥昔单抗在类风湿关节炎患者中应谨慎使用。在COVID-19疫苗接种前后停用甲氨蝶呤可提高免疫原性，但可能会增加类风湿关节炎病情复发的风险。
