BIOLOGICAL THERAPIES IN CHILDREN WITH RHEUMATIC DISEASES DURING
THE COVID-19 PANDEMIC: A SINGLE CENTER EXPERIENCE
To the Editor,
The SARS-CoV-2 infection (COVID-19), which causes severe acute
respiratory syndrome, was accepted as a pandemic by the World Health
Organization (WHO) on March 11, 2020, resulting in 50.030.121 confirmed
cases of COVID-19 (WHO. Coronavirus disease 2019 Situation
reports.
https:
// www. who. Int / emergencies / diseases / novel-coronavirus-2019 /
situation-reports, last access 9 November 2020). Patients with
rheumatic diseases are known to have increased infectious risks due to
usage of immunosuppressive drugs.1,2 Our aim is to
determine the frequency and course of COVID 19 of patients who use
biological agents for childhood rheumatic diseases.
We surveyed to determine the status of our patients who received
biological treatment during the outbreak. The survey was administered to
parents by telephone contacts and outpatient visits between
11th March and 10th October 2020.
There were 52 patients (28 F/ 24 M, mean age 12.9±4.1 years) who were
treated with biological therapies in our clinic. The overall study
population included juvenile idiopathic arthritis (JIA) (n=33, 63%),
colchicine-resistant familial Mediterranean fever (FMF) (n=13, 25%),
idiopathic uveitis (n=2, 3.8%), systemic lupus erythematosus (SLE)
(n=2, 3.8%), Behcet’s disease (n=1, 1.9%), granulomatosis with
polyangiitis (n=1, 1.9%) and deficiency of adenosine deaminase 2
(DADA2) (n=1, 1.9%). All patients were treated with biological
therapies; 26 etanercept, 17 canakinumab, 6 adalimumab, 2 rituximab, 1
infliximab.
Seven out of 52 patients had contact with ones who were positive for
COVID-19 (Table 1). PCR tests were performed on 5 of them and only one
patient with the treatment of adalimumab had a complaint of cough and
weakness was positive. This patient continued adalimumab therapy without
interruption. We evaluated the patient one month after the onset of
COVID-19 infection and her physical examination findings were all normal
without any complaints. COVID-19 was detected in the household of three
FMF patients who received canakinumab. The COVID PCR tests were
performed on two patients were found to be negative. Three FMF patients
treated with canakinumab were tested for COVID-19 due to complaints of
fever and arthralgia and found to be negative.
During the 28-week pandemic period that started on March 11, 2020 in
Turkey, COVID-19 was not detected in 51 of our 52 patients with
rheumatic disease using biological therapies. Annapureddy et
al.3 showed that even though the risk of COVID-19
infection remains the same between the patients with biologics and
without biologics, the risk of hospitalizations and need for critical
care services appear to be low in patients on the immunosuppressive
medications. Yıldız et al.4 reported that their two
JIA patients on biological therapy were positive for COVID-19 and they
did not develop either severe disease course. Similarly, in our study,
only one patient on biological therapy was positive for COVID-19 and the
patient didn’t develop severe disease course.
Our preliminary experience with a small number of patients is hopeful
for pediatric patients with rheumatic diseases that require biological
therapy. Currently, there are no data recommending discontinuation of
treatment in these patients.5 Our results also support
this suggestion.