Poster Session A
Infection-related rheumatic syndromes
Pei-Hsinq Lai, MD
Taipei City Hospital
Taichung, Taiwan
No financial relationships with ineligible companies to disclose
Post-COVID interstitial lung disease (post-COVID ILD) is a critical sequelae yet the role of immunomodulatory therapies remains unclear. We explored to characterize post-COVID ILD in patients with rituximab-treated immune mediated inflammatory diseases (IMID), and using adjunctive biologic disease-modifying anti-rheumatic drugs (bDMARDs) as treatment.
Methods:
In the NTUH-RTX cohort, we included IMID patients with COVID-19 infection during September 2022 and January 2024, received adjunctive bDMARDs in addition to tocilizumab (TCZ) for post-COVID ILD. Patients with repeat COVID-19 infection > 60 days apart were calculated as separate events. The demographics, serum markers and medical outcomes were systematically reviewed from the electronic health records.
A total of 28 post-COVID ILD events in 23 IMID patients were included. Table 1 and 2 summarized the characteristics. The median age was 52 and 21.7% had ILD before COVID-19 infection. Five patients had repeat COVID-19 infection. All-cause mortality was 39.1%. 64.2% of the survivors achieved oxygen independence within 90 days. Among the 28 included post-COVID ILD events, 16 (57.1%) in ABA group, 5 (17.9%) in BEL group and 7 (25.0%) in TCZ-only group. All events utilizing combinational extended antiviral regimen survived (Fig 1A). Stratified with ABA exposure, no between-group difference regarding demographics, concomitant medications or serum markers yet numerically less combinational extended antiviral regimen users in the ABA group. Poor serum ferritin recovery (p=0.041), higher all-cause mortality (p=0.054), and numerically higher subsequent hospitalization (p=0.087) while less oxygen independence were seen in the ABA group (Fig 1B-D). In comparing BEL vs. ABA group, higher serum ferritin significant responses (p=0.053) were seen in the BEL group. No mortality detected in the BEL group (Fig 1E-F). No differences regarding subsequent hospitalizations for the survivors in ABA and BEL groups. This study highlights new evidence of belimumab use in IMID patients. Adjunctive belimumab for refractory post-COVID ILD exerts favorable ferritin recovery and survival. Combinational extended antiviral regimen potentially reduces mortality in post-COVID ILD. Further studies are needed to assess the clinical implications of this study, investigate the role of B-cell activating factor (BAFF) signaling in COVID-19 ILD especially for patients under chronic B cell depletion, and if belimumab’s anti-atherogenic potential attenuate post-COVID hyperinflammation.
In this analysis, the patients were categorized based on the mechanism of adjunctive bDMARDs received for post-COVID ILD: adjunctive abatacept (ABA), adjunctive belimumab (BEL) and TCZ-only. We defined the significant ferritin response as serum ferritin recovery over 80% or normalization after bDMARDs initiation. Outcomes included significant ferritin response, all-cause mortality, subsequent hospitalization and oxygen independence (within 90 days). Associations with outcomes were explored using Chi-square test or Mann-Whitney U-test. The Kaplan-Meier method with log-rank test was adopted for analysis. All analyses were conducted via R software.
Results:
Conclusion:
Table 1. Characteristics of the 23 included IMID patients with post-COVID ILD
Table 2. Characteristics of the 28 included post-COVID ILD events
P. Lai: None; C. Lu: None; S. Hsieh: None.