COVID-19 pandemic and biological therapy in rheumatologic disorders: how to deal with?

The outbreak of coronavirus disease 2019 (COVID-19) has involved more than 159 countries and more than 5 million people worldwide. A 40-year-old man with a history of rheumatoid arthritis treated with prednisolone, Disease-Modifying Anti-Rheumatic Drugs (DMARDs), and biologic agents was admitted wit...

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Bibliographic Details
Published in:	Reumatismo Vol. 72; no. 3; pp. 173 - 177
Main Authors:	Ahmadinejad, Z, Assari, R, Ayoobi Yazdi, N, Mazloomi, S-H, Javanshayani, P, Khalili Afousi, H, Ziaee, V
Format:	Journal Article
Language:	English
Published:	Italy PAGEPress Publications 19-11-2020
Subjects:	Adalimumab - administration & dosage Adult Antirheumatic Agents - administration & dosage Antiviral Agents - administration & dosage Arthritis, Rheumatoid - complications Arthritis, Rheumatoid - drug therapy Azathioprine - administration & dosage Betacoronavirus Biological Therapy Clinical Laboratory Techniques - methods Coronavirus Infections - complications Coronavirus Infections - diagnosis Coronavirus Infections - drug therapy Coronavirus Infections - epidemiology Coronaviruses COVID-19 COVID-19 pandemic COVID-19 Testing Drug Combinations Drug Therapy, Combination - methods Humans Lopinavir - administration & dosage Male Methotrexate - administration & dosage Monoclonal antibodies Oseltamivir - administration & dosage Pandemics Pneumonia, Viral - complications Pneumonia, Viral - diagnosis Pneumonia, Viral - drug therapy Pneumonia, Viral - epidemiology Prednisolone - administration & dosage rheumatologic disorders Ritonavir - administration & dosage SARS-CoV-2
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Summary:	The outbreak of coronavirus disease 2019 (COVID-19) has involved more than 159 countries and more than 5 million people worldwide. A 40-year-old man with a history of rheumatoid arthritis treated with prednisolone, Disease-Modifying Anti-Rheumatic Drugs (DMARDs), and biologic agents was admitted with chief complaints of fever, chills, malaise, myalgia, and dyspnea. Chest computed tomography showed bilateral subsegmental atelectasis and diffuse ground-glass opacities in both lungs inducing the suspicion of COVID-19 infection. The oro-nasopharynx swab sample for COVID-19 polymerase chain reaction was positive. In addition to supportive care, lopinavir/ritonavir 400/100 mg twice daily and oseltamivir (75 mg) twice daily were started in combination with a starting dose of hydroxychloroquine (400 mg). The methotrexate dose was decreased, and the dose of prednisolone was increased to 30 mg for 10 days. Azathioprine and adalimumab were continued at previous doses. The use of biologic agents and DMARDs in rheumatic patients is a serious challenge in the COVID-19 pandemic. In conclusion, during the COVID-19 pandemic, due to the key roles of cytokines in the promotion of the disease, the rheumatic patients may benefit from continuing their previous treatment, which may have protective effects.
ISSN:	0048-7449 2240-2683
DOI:	10.4081/reumatismo.2020.1289