[1] was limited by its small sample size, it does however indicate a possibility for differential risk of adverse clinical outcomes among individuals with systemic rheumatic disease based on the type of biological providers received

[1] was limited by its small sample size, it does however indicate a possibility for differential risk of adverse clinical outcomes among individuals with systemic rheumatic disease based on the type of biological providers received. the effect of biological disease-modifying antirheumatic medicines within the clincical?results of individuals with rheumatoid arthritis?who developed?severe infections (non-COVID-19) and reported that both subgroup?of?individuals who also received tumor necrosis factor-alpha inhibitors and subgroup of?patients who also received biological providers other than tumor necrosis factor-alpha inhibitors had reduced odds for development of sepsis and reduced odds of mortality. Although the study by Loarce-Martos et al. [1] was limited by its small sample size, it does however indicate a possibility for differential risk of adverse clinical results among individuals with systemic rheumatic disease based on the type of PNRI-299 DTX1 biological providers received. Particularly, rituximab causes B cell depletion that can be associated with decreased antibody production. This is best demonstrated inside a pooled analysis of 2578 individuals who received rituximab (along with methotrexate) in medical trials for rheumatoid arthritis where the proportion of individuals with low immunoglobulin (Ig)M 6?weeks after each course of treatment increased successively from 10% upon the first program to 40% upon the fifth program [5]. Even though proportion PNRI-299 of individuals with low IgG six months after each course of treatment remained stable, there were 5% of individuals with a level of IgG below the lower limit of normal occurred at any point during follow-up. Neutralizing antibody reactions against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen responsible for COVID-19, are usually comprised of IgM and IgG, where the serum of individuals with COVID\19 usually consists of IgM and/or IgG antibodies to the spike protein of the SARS\CoV-2 envelope by day time 14 after sign onset [6C8]. Consequently, long-term administration of rituximab may impair the priming of antibody reactions to neutralize viral replication, which clarifies the unfavorable medical results among COVID-19 individuals with systemic rheumatic disease receiving rituximab. On the other hand, the use of biologic cytokine inhibitors, such as tumor necrosis factor-alpha inhibitors may not carry the same risk for unfavorable medical results among COVID-19 individuals with systemic rheumatic disease since these providers may dampen cytokine storm associated with COVID-19. The publication of this descriptive study by Loarce-Martos et al. should quick more evaluation on the risk of COVID-19-related adverse clinical results with different types of biological providers indicated for systemic rheumatic disease. Before growing of more evidence, it is probably best that we take a prudent approach with program? monitoring of serum immunoglobulin levels and thought for discontinuation?of rituximab in individuals who develop hypogammaglobulinemia amid the COVID-19 pandemic. Compliance with ethical requirements Conflicts of interestChia Siang Kow and Syed Shahzad Hasan declare PNRI-299 that they have no discord of interest. Footnotes Publisher’s Notice Springer Nature remains neutral with regard to jurisdictional statements in published maps and institutional affiliations..