Editor’s note: ACR on Air, the official podcast of the ACR, dives into topics important to the rheumatology community, such as the latest research, solutions for practice management issues, legislative policies, patient care and more. Twice a month, host Jonathan Hausmann, MD, a pediatric and adult rheumatologist in Boston, interviews clinicians and rheumatology professionals on important topics in rheumatology. In a series for The Rheumatologist, we provide highlights from these relevant conversations. Listen to the podcast online or download and subscribe to ACR on Air wherever you get your podcasts. Here we highlight , “B Cell-Depleting Therapies and COVID-19,” which aired on July 19, 2022.
The COVID-19 pandemic offered many lessons for rheumatologists in the use of B cell-depleting therapies and protection against this virus, according to Alfred Kim, MD, PhD, an assistant professor of medicine in the Division of Rheumatology, Washington University, St. Louis. Dr. Kim has done extensive research related to B cells and discussed B cell-depleting therapies and COVID-19 with podcast host Jonathan Hausmann, MD, for an episode of ACR on Air.
Early Pandemic Research
Dr. Kim
Dr. Kim said he had no expectations for how COVID-19 would affect immunosuppressed patients in early 2020. However, “I think by early summer, it was pretty clear that the presence of type 1 interferons, which are anti-viral cytokines, was critical in controlling that transition or the progression of COVID-19 into something more severe. Also, Akiko Iwasaki, PhD, at [Yale School of Medicine, New Haven, Conn., and colleagues] showed that the timing of when you started generating antibodies was also critical,” Dr. Kim says. “Both of these ended up as core correlates of protection—immune wise—to be able to limit the severity of COVID-19.”1
By the end of that summer, further research helped establish that rheumatology patients were at significant risk due to COVID-19, Dr. Kim says.
Dr. Hausmann
Dr. Hausmann notes that, at that time, some immunosuppressive medications were thought to increase the risk of developing COVID-19 or severe outcomes, but it was unclear which medications. Additionally, rheumatologists were concerned that if patients stopped immunosuppression, their underlying disease would flare—also not a good outcome in an infection setting.
Research during the pandemic from the COVID-19 Global Rheumatology Alliance, EULAR and others showed the biggest threat to these patients was likely B cell-depleting therapies for rheumatoid arthritis, lupus and multiple sclerosis.2
