Impact of B-cell depletion therapy on hospitalized COVID-19 patients

A recent study posted to the Preprints with The Lancet* server assessed the clinical outcomes in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, who were previously treated with B-cell depletion therapy.   

Study: Clinical Outcomes of Patients Previously Treated with B-Cell Depletion Therapy Hospitalized with COVID-19: Results from the Johns Hopkins Crown Registry. Image Credit: Halfpoint/Shutterstock
Study: Clinical Outcomes of Patients Previously Treated with B-Cell Depletion Therapy Hospitalized with COVID-19: Results from the Johns Hopkins Crown Registry. Image Credit: Halfpoint/Shutterstock

Various therapy approaches target B cells or B lymphocytes to treat indications ranging from rheumatologic diseases to malignancy. However, patients treated with similar therapies are rendered with a weak immune system which could potentially increase their risk of coronavirus disease 2019 (COVID-19) severity.   

About the study

The present study compared the outcomes of hospitalized COVID-19 patients with a history of prior B-cell depleting therapy with matched patients to assess the impact of B-cell depletion on SARS-CoV-2 outcomes.

The team gathered the inpatient and outpatient clinical records of COVID-19 patients. Patients eligible for the study were treated in the Johns Hopkins health system between 1 March 2020 and 30 November 2021. The team identified patients who had previously received B-cell depletion therapy and were subsequently hospitalized after a laboratory-confirmed COVID-19 diagnosis. Treatment therapy for B-cell depletion included drugs like rituximab, obinutuzumab, ocrelizumab, ibritumomab, ofatumumab, and some generic formulations.

The control population consisted of patients who had not undergone B-cell depletion therapy and who were matched with the study patients based on variables like age, the timing of hospitalization, gender, race, the severity of disease, and type of COVID-19 therapy. 

The primary outcome of the study was the duration from hospital admission to the death of the patient. The secondary outcome was the duration from hospital admission to a compound manifestation of severe illness or death of the patient. Patients who received a discharge from the hospital were monitored for 30 days post-discharge.

Another outcome of the study was the duration of clinical improvement from the admission of the patient. This clinical improvement is represented by a 2-point reduction in the World Health Organization (WHO) severity score or the discharge of the patient from the hospital within 30 days.

According to the WHO severity scale, a score of 6 and above indicated severe illness while the highest score noted in the first 12 hours of patient admission defined disease severity at admission. A lack of clinical improvement was monitored on the last day of the follow-up or at 30 days, whichever occurred first, while the death of the patient was censored at 30 days.

A prespecified subgroup analysis was also performed to assess the impact of B-cell depletion treatment on COVID-19 patients within 90 days before COVID-19 hospitalization.

Results

The study results showed that 50 patients eligible for the study had a history of receiving B-cell depletion therapy and were COVID-19 positive. A total of 212 patients with SARS-CoV-2 infection but no B-cell depletion therapy exposure were selected as the control group.

A 30-day mortality rate of 6% was found in patients with a history of receiving B-cell depletion therapy as compared to 4.2% in the control cohort. The time to the manifestation of severe illness or death in the B-cell depletion group since hospital admission was 2.4 days and 2.1 days in the control group. Also, patients with a history of B-cell depletion treatment required a longer time to show clinical improvement as compared to the control group; the median time taken by the B-cell depleted group for clinical improvement was 6.3 days, and that by the control cohort was 4.1 days.

Subgroup analysis performed within 90 days of hospitalization of the B-cell depleted group for COVID-19 also showed that these patients required 6.3 days to exhibit clinical improvement while the control cohort required 4.1 days.     

Conclusion

The study findings showed that patients with a history of receiving B-cell depletion therapy experienced longer durations of COVID-19-related hospitalizations; however, no significant difference was observed in their mortality rates as compared to the control patients.

The researchers believe that close clinical monitoring and hospitalization of such individuals can help them receive B-cell depleting therapies amid the SARS-CoV-2 pandemic. Extensive research on the impact of SARS-CoV-2 vaccination on COVID-19 disease outcomes, the efficiency of prophylactic treatment with tixagevimab and cilgavimab, and the effect of emerging SARS-CoV-2 variants on the outcomes is essential to provide sufficient protection to this population.

*Important notice

Preprints with The Lancet publish preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Bhavana Kunkalikar

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.

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