When the investigators compared hospital stays of patients who received rituximab and those who did not, they observed a prolonged hospital stay and increased risk of morbidity, mortality and potential infection-related sequelae. Although more patients treated with rituximab died, after the researchers adjusted for potential confounders, they found the risk of death did not increase significantly compared with patients not treated with rituximab, reinforcing to the authors the importance of associated comorbidities.
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The authors conclude by suggesting it may be wise to delay rituximab therapy in patients with rheumatoid arthritis. However, they note the decision to delay therapy may be more difficult in patients with connective tissue disorders or vasculitis, who are at risk greater risk of disease relapse.
Additionally, Dr. Calabrese says the findings have implications for the timing and choice of COVID-19 vaccine. It appears vaccines given within five months of the last rituximab dose are not as effective. Therefore, if possible, experts recommend giving the COVID-19 vaccine at least four to six months after the last infusion and four to six weeks before the next infusion.3 Likewise, administering a two-dose vaccine may be more challenging to coordinate for patients who are due for their rituximab therapy than a single-dose vaccine. It may not be feasible for patients to delay their treatment.
“This study confirms the importance of timing of vaccines in patients receiving rituximab, especially because this group also has increased risk of poor outcomes if infected with SARS-CoV-2,” Dr. Calabrese says.
Lara C. Pullen, PhD, is a medical writer based in the Chicago area.
References
- FAI2R /SFR/SNFMI/SOFREMIP/CRI/IMIDIATE consortium and contributors. Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: Data from the French RMD COVID-19 cohort of 694 patients. Ann Rheum Dis. 2020 Dec 2;80(4):527–538. Online ahead of print.
- Avouac J, Drumez E, Hachulla E, et al. COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: A cohort study. Lancet Rheumatol. 2021 Mar 25. Online ahead of print.
- Dougados M. Managing patients with rheumatic diseases treated with rituximab during the COVID-19 pandemic. Lancet Rheumatol. 2021 Jun;3(6):e395–e396. Epub 2021 Mar 25.