Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland.
Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, Turku, Finland.
Eur J Clin Microbiol Infect Dis. 2024 Apr;43(4):723-734. doi: 10.1007/s10096-024-04776-0. Epub 2024 Feb 15.
In clinical practice, we observed an apparent overrepresentation of COVID-19 patients on anti-CD20 monoclonal antibody therapy. The aim of this study was to characterize the clinical picture of COVID-19 in these patients.
All adult patients from Turku University Hospital, Turku, Finland, with COVID-19 diagnosis and/or positive SARS-CoV-2 PCR test result up to March 2023, and with anti-CD20 therapy within 12 months before COVID-19 were included. Data was retrospectively obtained from electronic patient records.
Ninety-eight patients were identified. 44/93 patients (47.3%) were hospitalized due to COVID-19. Patients with demyelinating disorder (n = 20) were youngest (median age 36.5 years, interquartile range 33-45 years), had less comorbidities, and were least likely to be hospitalized (2/20; 10.0%) or die (n = 0). COVID-19 mortality was 13.3% in the whole group, with age and male sex as independent risk factors. Persistent symptoms were documented in 33/94 patients (35.1%) alive by day 30, in 21/89 patients (23.6%) after 60 days, and in 15/85 after 90 days (17.6%), mostly in patients with haematological malignancy or connective tissue disease. Prolonged symptoms after 60 days predisposed to persistent radiological findings (odds ratio 64.0; 95% confidence interval 6.3-711; p < 0.0001) and persistently positive PCR (odds ratio 45.5, 95% confidence interval 4.0-535; p < 0.0001). Several patients displayed rapid response to late antiviral therapy.
Anti-CD20 monoclonal antibody therapy is associated with high COVID-19 mortality and with a phenotype consistent with prolonged viral pneumonia. Our study provides rationale for retesting of immunocompromised patients with prolonged COVID-19 symptoms and considering antiviral therapy.
在临床实践中，我们观察到 COVID-19 患者在接受抗 CD20 单克隆抗体治疗时明显过多。本研究旨在描述这些患者 COVID-19 的临床特征。
纳入 2023 年 3 月前在芬兰图尔库大学医院接受 COVID-19 诊断和/或 SARS-CoV-2 PCR 检测结果阳性且在 COVID-19 前 12 个月内接受抗 CD20 治疗的所有成年患者。数据从电子病历中回顾性获取。
共纳入 98 例患者。44/93 例（47.3%）患者因 COVID-19 住院。患有脱髓鞘疾病（n=20）的患者年龄最小（中位年龄 36.5 岁，四分位间距 33-45 岁），合并症较少，住院（2/20；10.0%）或死亡（n=0）的可能性最低。全组 COVID-19 死亡率为 13.3%，年龄和男性是独立的危险因素。30 天时存活的 94 例患者中有 33 例（35.1%）存在持续性症状，60 天时存活的 89 例患者中有 21 例（23.6%），90 天时存活的 85 例患者中有 15 例（17.6%）存在持续性症状，这些患者大多患有血液系统恶性肿瘤或结缔组织疾病。60 天后症状持续存在与持续性影像学表现（比值比 64.0；95%置信区间 6.3-711；p<0.0001）和持续阳性 PCR（比值比 45.5，95%置信区间 4.0-535；p<0.0001）相关。一些患者接受晚期抗病毒治疗后症状迅速缓解。
抗 CD20 单克隆抗体治疗与 COVID-19 死亡率高相关，其临床特征与持续性病毒性肺炎一致。本研究为免疫功能低下的 COVID-19 症状持续患者提供了重新检测和考虑抗病毒治疗的依据。
