ArticleClinical rheumatology2025
Rituximab in the COVID-19 era: The impact of albumin and IgG on patients with immune-mediated inflammatory diseases.
Article in Clinical rheumatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo identify factors associated with COVID-19 outcomes in patients with immune-mediated inflammatory diseases (IMID) treated with rituximab (RTX) and determine candidates for RTX administration/maintenance.
methodsWe conducted a case-control study of RTX-treated IMID patients with COVID-19 (May 2021-April 2023), including 32 hospitalized cases and 64 non-hospitalized controls matched by age, sex, IMID diagnosis. Logistic regression was used to analyze pre-COVID biochemical markers within 3-months and RTX-specific factors. Secondary outcomes in hospitalized cases included COVID-19 severity, viral shedding, and all-cause mortality.
resultsHigher RTX exposure was associated with reduced glucocorticoid dependence and higher pre-COVID albumin levels while correlated with lower IgG levels. However, lower pre-COVID albumin (OR: 0.231, p = 0.012) and higher maintenance glucocorticoid use (OR: 1.170, p = 0.007) were independently associated with hospitalization, regardless of IgG levels or RTX exposure. Among hospitalized cases, lower admission albumin (albumin_D
conclusionPre-COVID albumin and glucocorticoid dependence are independently associated with hospitalization regardless of RTX-specific factors. Admission albumin predicts secondary outcomes. Risk of rituximab on COVID-19 outcomes is not universal. Albumin ≥ 3.45 g/dL and IgG ≥ 687 mg/dL identify lower-risk patients, providing guidance for safer RTX administration. Key Points • Risk of rituximab on COVID-19 outcomes in immune-mediated inflammatory diseases is not universal. Serum albumin and IgG levels are critical to determine the COVID-19 outcomes. • Patients with serum albumin ≥ 3.45 g/dL and IgG ≥ 687 mg/dL demonstrate a lower risk associated with rituximab, providing guidance for its safer administration in the post-COVID-19 era amidst potential challenges from emerging infections. • Serum albumin serves as a significant prognostic marker for COVID-19 outcomes in patients receiving rituximab treatment. • The timing of the most recent rituximab infusion does not affect COVID-19 outcomes in these patients.
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