B Cell Depleting Therapy Associated With Severe COVID-19

Regardless of vaccination status, patients with immune-mediated inflammatory diseases receiving B cell depleting therapy are at risk for severe and fatal COVID-19, according to study findings published online ahead of print in Arthritis & Rheumatology.

“Our data clearly show that breakthrough infection in this population is associated with severe outcomes, as 39.2% required hospitalization, 14.8% required critical care, and 8.1% died,” wrote researchers from the Cleveland Clinic. “Thus we confirm that immune-mediated inflammatory disease patients on B cell depleting therapy appear vulnerable to breakthrough infections and, most importantly, are attended by severe outcomes.”

The retrospective cohort study included data for 1696 patients on B cell depleting therapy for immune-mediated inflammatory diseases who received at least one dose of SARS-CoV-2 vaccine. Among them, 4.4%, or 74 patients, developed breakthrough COVID-19. The most common diagnosis in the cohort was multiple sclerosis, although the distribution of rheumatic and neuroinflammatory disease was nearly equal, according to the study.

Upon contracting breakthrough COVID-19, 39.2% of the patients were hospitalized, and 8.1% died. Among the 21 patients who received outpatient anti-SARS-CoV-2 monoclonal antibodies, one hospitalization and no deaths occurred.

A comparator analysis of 1437 patients also on B cell depleting therapy but who were not vaccinated showed 3.9%, or 57 patients, contracted COVID-19 over the same period. Among them, 49.1% required hospitalization, and 12.3% died.

“For now, enhanced nonpharmacologic measures (masking, social distancing, etc.) will remain important; expanded access to pre-exposure prophylaxis with anti-SARS-CoV-2 monoclonal antibodies effective against prevalent variants and access to emerging antiviral therapies will be vital,” the authors advised. “Enhanced education of both patients and the providers who care for them to increase their awareness and utilization of current and future outpatient therapies is urgently needed.”

—Jolynn Tumolo

Reference:
Calabrese CM, Kirchner E, Husni EM, et al. Breakthrough SARS-CoV-2 infections in immune mediated disease patients undergoing B cell depleting therapy: a retrospective cohort analysis. Arthritis Rheumatol. Published online July 6, 2022.