COVID-19 und rheumatische Erkrankungen – bisherige Erkenntnisse der Pandemie

Was ist neu?

COVID-19 bei Patienten mit entzündlich-rheumatischen Erkrankungen Eine erhöhte Entzündungsaktivität bei Patienten mit entzündlich-rheumatischen Erkrankungen ist mit schwereren COVID-19-Verläufen assoziiert. Der Einsatz von Glukokortikoiden (mehr als 5 mg Prednisolon/Tag) kann einen schwereren Verlauf von COVID-19 begünstigen. Glukokortikoide von > 10 mg über einen längeren Zeitraum müssen angesichts zahlreicher steroidsparender Alternativen sehr gut begründet sein.[*]

COVID-19 und Immunmodulation Bereits frühe Fallberichte deuteten auf einen negativen Einfluss von Rituximab auf den Verlauf von COVID-19 hin. Mittlerweile konnten in mehreren Arbeiten höhere Raten von Hospitalisierungen und COVID-19-assoziiertem Tod nachgewiesen werden. Ob ein vergleichbarer Effekt auch unter der Therapie mit Januskinase-Inhibitoren bei Patienten mit rheumatoider Arthritis besteht, wird derzeit untersucht.

COVID-19-Impfungen Alle in Deutschland zur Verfügung stehenden Impfstoffe gegen COVID-19 weisen bisher ein sehr gutes Sicherheitsprofil sowie kein relevant erhöhtes Risiko für Krankheitsschübe auf. Es wird keine generelle Pausierung oder Reduktion der Immunmodulation zum Erzielen einer besseren Impfantwort empfohlen. Eine Ausnahme stellt die Therapie mit Rituximab dar.

Abstract

Older age, cardiovascular comorbidities, chronic lung diseases, and GC use were identified as independent risk factors for severe courses of COVID-19 resulting in the need of hospitalization. Glucocorticoid dosis of > 10 mg over a longer period of time should be very carefully used as there are various immunomodulatory alternatives. Of particular note, disease activity of inflammatory rheumatic diseases (IRD) was also identified as an independent predictor of COVID-19 related hospitalization.

Already in the early phase of the pandemic case reports of fatal courses of IRD patients under treatment with rituximab were reported. Meanwhile, several data could demonstrate higher rates of hospitalization and COVID-19-related deaths. Whether a similar effect is detectable regarding Janus kinase inhibitors in patients with rheumatoid arthritis is currently under investigation.

Preliminary data indicate that all available COVID-19 vaccines in Europe are not associated with higher rates of disease flares or differences of side effect profiles compared to the general population. There is no recommendation to discontinue or reduce immunomodulatory treatment in general to achieve better immune response. In the case of Rituximab, consideration should be given to postponing or switching to alternative therapies, taking into account the risk of reactivation of the underlying disease on the one hand and the improvement of a potential vaccine response on the other.

Schlüsselwörter

Immunmodulation - Impfungen - Glukokortikoide - Rituximab - Januskinase-Inhibitor

Key words

immunomodulation - vaccines - glucocorticoids - rituximab - janus kinase inhibitor

^* In dieser Arbeit wird aus Gründen der besseren Lesbarkeit das generische Maskulinum verwendet. Weibliche und anderweitige Geschlechteridentitäten werden dabei ausdrücklich mitgemeint, soweit es für die Aussage erforderlich ist.

Publication History

Article published online:
26 November 2021

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