Chavatza Katerina, Mastrostamati Elisavet, Charalampidis Charalampos, Antonogiannaki Elvira-Markela, Grigoropoulos Ioannis, Karofylakis Emmanouil, Gkolemi Foteini, Koromvokis Georgios, Kalara Electra, Sambatakaki Eleni, Fanouriakis Antonis, Thomas Konstantinos
Rheumatology-Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
RMD Open. 2025 Jul 21;11(3):e005756. doi: 10.1136/rmdopen-2025-005756.
COVID-19 may persist or relapse in patients on B-cell depleting biologic therapies.
To examine the rate and outcome of persistent-relapsing COVID-19 (prCOVID-19) in patients with autoimmune rheumatic diseases (AIRD) treated with rituximab (RTX).
Single-centre, retrospective cohort study of patients diagnosed with prCOVID-19 (June 2021 to January 2025). prCOVID-19 was defined as persistence of symptoms and lung imaging findings for >30 days, along with persistently positive or PCR-based conversion in upper or lower respiratory tract samples.
26 out of 225 (11.6%) AIRD patients, previously diagnosed with COVID-19 during RTX treatment period, developed 27 prCOVID-19 events (females: 20 (76.9%), median age: 61 years, median disease duration: 5.5 years, ≥3 COVID-19 vaccine doses: 20 (76.9%)). No prCOVID-19 infection in a control sample of 661 patients treated with other biologic/targeted synthetic/conventional synthetic disease-modifying antirheumatic drugs was documented. Median cumulative RTX dose was 12 g, while in 17 (68%) prCOVID-19 events, IgG levels were below 700 mg/L. Median duration of prCOVID-19 infection was 65 (IQR 74) days and median duration of hospitalisation 10.5 (IQR 14) days. 11 patients (42.3%) had ≥2 hospitalisations, 3 patients needed mechanical ventilation and 4 deaths were recorded. 59 of 113 (52.2%) nasopharyngeal PCR samples (NPS) and 12/17 (70.6%) bronchoalveolar lavage (BAL) PCR samples were positive during prCOVID-19. Bronchoscopy established the diagnosis of prCOVID-19 in 33% of events.
AIRD patients treated with RTX are at risk for prCOVID-19. In such patients, the diagnostic accuracy of NPS PCR is suboptimal, necessitating PCR testing in BAL when prCOVID-19 is highly suspected.
接受B细胞耗竭生物疗法的患者中，新冠病毒病（COVID-19）可能持续存在或复发。
研究接受利妥昔单抗（RTX）治疗的自身免疫性风湿病（AIRD）患者中持续性-复发性COVID-19（prCOVID-19）的发生率及转归。
对诊断为prCOVID-19（2021年6月至2025年1月）的患者进行单中心回顾性队列研究。prCOVID-19定义为症状和肺部影像学表现持续超过30天，同时上呼吸道或下呼吸道样本持续呈阳性或基于聚合酶链反应（PCR）出现转换。
225例AIRD患者中，26例（11.6%）在RTX治疗期间曾确诊COVID-19，发生了27次prCOVID-19事件（女性：20例（76.9%），中位年龄：61岁，中位病程：5.5年，≥3剂COVID-19疫苗接种：20例（76.9%））。在661例接受其他生物制剂/靶向合成/传统合成抗风湿药物治疗的对照样本中，未记录到prCOVID-19感染。RTX累积剂量中位数为12g，在17例（68%）prCOVID-19事件中，免疫球蛋白G（IgG）水平低于700mg/L。prCOVID-19感染的中位持续时间为65（四分位间距74）天，住院中位持续时间为10.5（四分位间距14）天。11例患者（42.3%）住院≥2次，3例患者需要机械通气，记录到4例死亡。在prCOVID-19期间，113份鼻咽PCR样本（NPS）中的59份（52.2%）和17份支气管肺泡灌洗（BAL）PCR样本中的12份（70.6%）呈阳性。支气管镜检查在33%的事件中确诊了prCOVID-19。
接受RTX治疗的AIRD患者有发生prCOVID-19的风险。在此类患者中，NPS PCR的诊断准确性欠佳，当高度怀疑prCOVID-19时，需要对BAL进行PCR检测。
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