Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia

In the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (covid-19),1 2 the preliminary experience reported by Monti S and colleagues3 suggests that patients with chronic arthritis (rheumatoid arthritis and spondyloarthritis) receiving bDMARDs (biologic disease-modifying anti-rheumatic drugs) or tsDMARDs (targeted synthetic DMARDs) may not exhibit an increased risk of severe covid-19. These data must be strengthened and confirmed at a larger scale, but remain positive in this drastic context. The authors rightly recommend a continuous surveillance of patients under immunosuppressants, especially since data are lacking in many systemic autoimmune/inflammatory diseases. Notably, anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a group of vasculitides that can involve the respiratory tract (upper and lower airways) and the recent outbreak of covid-19 raises many specific questions concerning the severity of viral infection in AAV patients as well as the therapy with rituximab. Indeed, rituximab, a monoclonal antibody targeting CD20, has become the cornerstone of treatment in the last decade, but is responsible for long-lasting B-cell depletion and potentially severe infectious events (IE) independently from covid-19.4 A recent observation from our centre illustrates some …