COVID-19 in rheumatic disease patients on immunosuppressive agents
COVID-19 in rheumatic disease patients on immunosuppressive agents
复制标题
DOI：
10.1016/j.semarthrit.2020.05.010
复制
发表时间：
2020-08-01
影响因子：
5
通讯作者：
Yao, Qingping
中科院分区：
文献类型：
--
作者：
Sharmeen, Saika;Elghawy, Ahmed;Yao, Qingping
目的：分析患有基础风湿性疾病（RD）的 COVID-19 患者使用免疫抑制剂的临床特征和转归。方法：通过回顾性图表回顾性研究对使用疾病缓解抗风湿药物（DMARD）的患有 RD 的 COVID-19 患者进行病例系列研究。文献检索找到了 9 项类似的单例和病例系列研究，也将其纳入其中。 结果：我院有 4 例 RD 住院的 COVID-19 患者，平均年龄为 57 +/- 21 岁。 2 名患者出现轻度感染，2 名患者出现严重的 COVID-19 相关呼吸道并发症，其中 1 名接受苏金单抗治疗的患者需要机械通气，1 名接受利妥昔单抗治疗的患者出现病毒性肺炎，需要补充氧合。所有 4 名患者的急性期反应物均升高，2 名患者患有轻度 COVID-19 并伴有淋巴细胞减少，2 名患者患有严重 COVID-19，但淋巴细胞计数正常且 IL-6 水平较高。没有患者表现出其潜在 RD 恶化。文献中有9项关于COVID-19的研究，涉及197例各种炎症性RD。大多数患者服用 DMARD 或生物制剂，其中最常用的是 TNF α 抑制剂。两名托珠单抗使用者出现轻度感染。两名患者正在服用利妥昔单抗，其中一名患者患有严重的 COVID-19，需要机械通气。 6 名患者接受苏金单抗治疗，其中 1 名患者住院治疗。总共 201 例病例中，有 12 例死亡，估计死亡率为 5.9% 结论：RD 患者容易感染 COVID-19。不同的 DMARD 或生物制剂可能对病毒性疾病进程产生不同的影响。服用羟氯喹、TNF α 拮抗剂或托珠单抗的患者可能患有轻度病毒性疾病。利妥昔单抗或苏金单抗可能会使病毒性疾病恶化。需要进一步研究。 (C) 2020 Elsevier Inc. 保留所有权利。
Objective: To analyze clinical characteristics and outcome of COVID-19 patients with underlying rheumatic diseases (RD) on immunosuppressive agents.Method: A case series of COVID-19 patients with RD on disease modifying anti-rheumatic drugs (DMARDs) were studied by a retrospective chart review. A literature search identified 9 similar studies of single cases and case series, which were also included.Results: There were 4 COVID-19 inpatients with RD from our hospital, and the mean age was 57 +/- 21 years. Two patients had a mild infection, and 2 developed severe COVID-19 related respiratory complications, including 1 patient on secukinumab requiring mechanical ventilation and 1 patient on rituximab developing viral pneumonia requiring supplemental oxygenation. All 4 patients had elevated acute phase reactants, 2 patients had mild COVID-19 with lymphopenia, and 2 patients had severe COVID-19 with normal lymphocyte counts, and high levels of IL-6. None of the patients exhibited an exacerbation of their underlying RD. In the literature, there were 9 studies of COVID-19 involving 197 cases of various inflammatory RD. Most patients were on DMARDs or biologics, of which TNF alpha inhibitors were most frequently used. Two tocilizumab users had a mild infection. Two patients were on rituximab with 1 severe COVID-19 requiring mechanical ventilation. Six patients were on secukinumab with 1 hospitalization. Of the total 201 cases, 12 died, with an estimated mortality of 5.9%Conclusion: Patients with RD are susceptible to COVID-19. Various DMARDs or biologics may affect the viral disease course differently. Patients on hydroxychloroquine, TNF alpha antagonists or tocilizumab may have a mild viral illness. Rituximab or secukinumab could worsen the viral disease. Further study is warranted. (C) 2020 Elsevier Inc. All rights reserved.