medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-8-135-143medsovet-5691Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYCOVID-19 и ревматология: так далеко, так близкоCOVID-19 and Rheumatology: so far, so closehttps://orcid.org/0000-0001-7091-2054БеловБ. С.BelovB. S.

Белов Борис Сергеевич, д.м.н., заведующий лабораторией изучения коморбидных инфекций и мониторинга безопасности лекарственной терапии

115522, Россия, Москва, Каширское шоссе, д. 34А

Boris S. Belov, Dr. of Sci. (Med.), Head of the Laboratory for the Study of Comorbid Infections and Monitoring the Safety of Drug Therapy

34А, Kashirskoe shosse, Moscow, 115522, Russia

belovbor@yandex.ruhttps://orcid.org/0000-0003-4327-6720МуравьеваН. В.MuravyevaN. M.

Муравьева Наталья Валерьевна, к.м.н., научный сотрудник лаборатории изучения коморбидных инфекций и мониторинга безопасности лекарственной терапии

115522, Россия, Москва, Каширское шоссе, д. 34А

Natalia V. Muravyeva, Cand. of Sci. (Med.), Researcher of the Laboratory for the Study of Comorbid Infections and Monitoring the Safety of Drug Therapy

34А, Kashirskoe shosse, Moscow, 115522, Russia

n-muravjeva@mail.ruhttps://orcid.org/0000-0001-9933-5350ТарасоваГ. М.TarasovaG. M.

Тарасова Галина Михайловна, к.м.н., старший научный сотрудник лаборатории изучения коморбидных инфекций и мониторинга безопасности лекарственной терапии

115522, Россия, Москва, Каширское шоссе, д. 34А

Galina M. Tarasova, Cand. of Sci. (Med.), Leading Researcher of the Laboratory for the Study of Comorbid Infections and Monitoring the Safety of Drug Therapy

34А, Kashirskoe shosse, Moscow, 115522, Russia

verizubgm@gmail.comНаучно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation20201407202008135143Copyright © Белов Б.С., Муравьева Н.В., Тарасова Г.М., 20202020Белов Б.С., Муравьева Н.В., Тарасова Г.М.Belov B.S., Muravyeva N.M., Tarasova G.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5691

Заболеваемость, вызванная новым коронавирусом COVID-19, расценивается мировым сообществом как чрезвычайная ситуация международного значения. Наряду с огромным социальным значением пандемия COVID-19 высветила ряд принципиально новых клинических и фундаментальных проблем иммунопатологии заболеваний человека. Данная проблема чрезвычайно актуальна для пациентов, страдающих иммуновоспалительными ревматическими заболеваниями (ИВРЗ), вследствие их более высокой подверженности инфекционным осложнениям. Достижение и сохранение контроля над активностью ИВРЗ играет важную роль в снижении частоты коморбидных инфекций у этих больных. Показано, что для пациентов с ИВРЗ, получающих активную противоревматическую терапию, по всей вероятности, не характерен повышенный риск респираторных или иных угрожающих жизни осложнений в рамках COVID-19 по сравнению с общей популяцией. С учетом необходимости постоянного наблюдения за больными, получающими указанную терапию, тем не менее следует избегать неоправданной «профилактической» ее отмены и тем самым повышать риск рецидива основного ИВРЗ. В статье также рассмотрены вопросы, касающиеся применения основных противоревматических препаратов при COVID-19. В настоящее время отсутствуют доказательства, подтверждающие терапевтическую и профилактическую эффективность хлорохина или гидроксихлорохина при COVID-19. Тоцилизумаб может рассматриваться в качестве «спасательной терапии» больных острым респираторным дистресс-синдромом в рамках COVID-19, если другие методы лечения не дали результатов или недоступны. Применение барицитиниба у госпитализированных больных пневмонией в рамках COVID-19 следует рассматривать с крайней осторожностью. Подчеркивается необходимость дальнейших исследований для оценки потенциальной роли барицитиниба для этих пациентов. В условиях отсутствия вакцины против COVID-19 при продолжающейся пандемии абсолютному большинству больных ИВРЗ следует настоятельно рекомендовать проведение вакцинации, в первую очередь против гриппа и пневмококковой инфекции. Это связано большим риском летальных исходов от инфекций дыхательных путей у ревматологических пациентов, особенно с учетом высокой поражаемости респираторного тракта при COVID-19.

The disease caused by the new coronavirus COVID-19 is considered by the world community as an emergency of internationalimportance. Along with the huge social importance, the COVID-19 pandemic has highlighted a number of principally new clinical and fundamental problems of immunopathology of human diseases. This problem is extremely urgent for patients suffering from immune-inflammatory rheumatic diseases (IIRD) due to their higher exposure to infectious complications. Achieving and maintaining control over the activity of IIRD plays an important role in reducing the incidence of comorbid infections in these patients. It has been shown that patients with IIRD undergoing active anti-rheumatic therapy are most likely not characterized by increased risk of respiratory or other life-threatening complications within COVID-19 compared to the general population. Given the need for continued monitoring of patients receiving these therapy, unjustified “prophylactic” cancellation should nevertheless be avoided, thereby increasing the risk of relapse of major IIRD. The article also discusses the issues related to the use of basic anti-rheumatic drugs in COVID-19. Currently there is no evidence to support the therapeutic and prophylactic efficacy of chloroquine or hydroxychloroquine in COVID-19. Tocilizumab can be considered as “lifesaving therapy” for patients with acute respiratory distress syndrome in COVID-19, if other treatments have failed or are unavailable. The use of baricitinib in hospitalized pneumonia patients as part of COVID-19 should be considered with extreme caution. The need for further research to assess the potential role of baricitinib for these patients is highlighted. In the absence of a COVID-19 vaccine in a continuing pandemic, vaccination against influenza and pneumococcal infection should be strongly recommended to the absolute majority of patients with IIRD. This is associated with a high risk of fatal respiratory infection in rheumatological patients, especially given the high respiratory tract involvement in COVID-19.

COVID-19иммуновоспалительные ревматические заболеваниянестероидные противовоспалительные препаратыглюкокортикоидыгидроксихлорохинтоцилизумаббарицитинибCOVID-19immune inflammatory rheumatic diseasesnon-steroidal anti-inflammatory drugsglucocorticoidshydroxychloroquinetocilizumabbaricitinibReferencesНасонов Е.Л. Коронавирусная болезнь 2019 (COVID-19): размышления ревматолога. Научно-практическая ревматология. 2020;58(2):123–132. doi: 10.14412/1995-4484-2020-123-132.Nasonov E.L. Coronavirus disease 2019 (COVID-19): a rheumatologist’s thoughts. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2020;58(2):123–132. (In Russ.) doi: 10.14412/1995-4484-2020-123-132.Kingsmore K.M., Grammer A.C., Lipsky P.E. Drug repurposing to improve treatment of rheumatic autoimmune inflammatory diseases. Nat Rev Rheumatol. 2020;16(1):32–52. doi: 10.1038/s41584-019-0337-0.Kingsmore K.M., Grammer A.C., Lipsky P.E. Drug repurposing to improve treatment of rheumatic autoimmune inflammatory diseases. Nat Rev Rheumatol. 2020;16(1):32–52. doi: 10.1038/s41584-019-0337-0.Lu R., Zhao X., Li J., Niu P., Yang B., Wu H. et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. doi: 10.1016/S0140-6736(20)30251-8.Lu R., Zhao X., Li J., Niu P., Yang B., Wu H. et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. doi: 10.1016/S0140-6736(20)30251-8.Xu X., Chen P., Wang J., Feng J., Zhou H., Li X. et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020;63(3):457–460. doi: 10.1007/s11427-020-1637-5.Xu X., Chen P., Wang J., Feng J., Zhou H., Li X et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020;63(3):457–460. doi: 10.1007/s11427-020-1637-5.Zhao Y., Zhao Z., Wang Y., Zhou Y., Ma Y., Zuo W. Single-cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2. BioRxiv. 2020;2020:01.26.919985. doi: 10.1101/2020.01.26.919985.Zhao Y., Zhao Z., Wang Y., Zhou Y., Ma Y., Zuo W. Single-cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2. BioRxiv. 2020;2020:01.26.919985. doi: 10.1101/2020.01.26.919985.Mehta P., McAuley D.F., Brown M., Sanchez E., Tattersall R.S, Manson J.J. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–1034. doi: 10.1016/S0140-6736(20)30628-0.Mehta P., McAuley D.F., Brown M., Sanchez E., Tattersall R.S, Manson J.J. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–1034. doi: 10.1016/S0140-6736(20)30628-0.Seguin A., Galicier L., Boutboul D., Lemiale V., Azoulay E. Pulmonary involvement in patients with hemophagocytic lymphohistiocytosis. Chest. 2016;149(5):1294–1301. doi: 10.1016/j.chest.2015.11.004.Seguin A., Galicier L., Boutboul D., Lemiale V., Azoulay E. Pulmonary involvement in patients with hemophagocytic lymphohistiocytosis. Chest. 2016;149(5):1294–1301. doi: 10.1016/j.chest.2015.11.004.Liu T., Zhang J., Yang Y., Ma H., Li Zh., Zhang J. et al. The potential role of IL-6 in monitoring severe case of coronavirus disease 2019. MedRxiv. 2020;03.01.20029769. doi: 10.1101/2020.03.01.20029769.Liu T., Zhang J., Yang Y., Ma H., Li Zh., Zhang J. et al. The potential role of IL-6 in monitoring severe case of coronavirus disease 2019. MedRxiv. 2020;03.01.20029769. doi: 10.1101/2020.03.01.20029769.Gao Y., Li T., Han M., Li X., Wu D., Xu Y. et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;2020:10.1002/jmv.25770. doi: 10.1002/jmv.25770.Gao Y., Li T., Han M., Li X., Wu D., Xu Y. et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;2020:10.1002/jmv.25770. doi: 10.1002/jmv.25770.Au K., Reed G., Curtis J.R., Kremer J.M., Greenberg J.D., Strand V., Furst D.E. High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70(5):785–791. doi: 10.1136/ard.2010.128637.Au K., Reed G., Curtis J.R., Kremer J.M., Greenberg J.D., Strand V., Furst D.E. High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70(5):785–791. doi: 10.1136/ard.2010.128637.Белов Б.С., Буханова Д.В., Тарасова Г.М. Инфекции нижних дыхательных путей при ревматических заболеваниях. Современная ревматология. 2018;12(1):47–54. doi: 10.14412/1996-7012-2018-1-47-54.Belov B.S., Bukhanova D.V., Tarasova G.M. Lower respiratory tract infections in rheumatic diseases. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2018;12(1):47–54. (In Russ.) doi: 10.14412/1996-7012-2018-1-47-54.Каратеев А.Е., Насонов Е.Л., Лила А.М. Вызывают ли НПВП специфические осложнения при коронавирусной инфекции COVID-19? Научно- практическая ревматология. 2020;58(2). Режим доступа: https://rheumatolog.su/media/media/2020/04/03/npr_2020_2.pdf.Karateev A.E., Nasonov E.L., Lila A.M. Do NSAIDs cause specific complications in COVID-19 coronavirus infection? Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2020;58(2). (In Russ.) Available at: https://rheumatolog.su/media/media/2020/04/03/npr_2020_2.pdf.Schenfeld J., Iles J., Trivedi M., Accortt N.A. Dose relationship between oral glucocorticoids and tumor necrosis factor inhibitors and the risk of hospitalized infectious events among patients with rheumatoid arthritis. Rheumatol Int. 2017;37(7):1075–1082. doi: 10.1007/s00296-017-3679-4.Schenfeld J., Iles J., Trivedi M., Accortt N.A. Dose relationship between oral glucocorticoids and tumor necrosis factor inhibitors and the risk of hospitalized infectious events among patients with rheumatoid arthritis. Rheumatol Int. 2017;37(7):1075–1082. doi: 10.1007/s00296-017-3679-4.Ni Y.N., Chen G., Sun J., Liang B.M., Liang Z.A. The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and metaanalysis. Crit Care. 2019;23(1):99. doi: 10.1186/s13054-019-2395-8.Ni Y.N., Chen G., Sun J., Liang B.M., Liang Z.A. The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and metaanalysis. Crit Care. 2019;23(1):99. doi: 10.1186/s13054-019-2395-8.Насонов Е.Л., Лила А.М., Мазуров В.И., Белов Б.С., Каратеев А.Е., Дубинина Т.В. и др. Коронавирусная болезнь 2019 (COVID-19) и иммуновоспалительные (аутоиммунные) ревматические заболевания. Проект рекомендаций Общероссийской общественной организации «Ассоциация ревматологов России». Режим доступа: https://rheumatolog.ru/sites/default/files/klinicheskie_rekomendacii_koronavirusnaya_bolezni_i_rz_poslednyaya_versiya_0.pdf.Nasonov E.L., Lila A.M., Mazurov V.I., Belov B.S., Karateev A.E., Dubinina T.V. et al. Coronavirus Disease 2019 (COVID-19) and immune (autoimmune) rheumatic diseases. Project of recommendations of the All-Russian Public Organization “Association of Rheumatologists of Russia”. (In Russ.) Available at: https://rheumatolog.ru/sites/default/files/klinicheskie_rekomendacii_koronavirusnaya_bolezni_i_rz_poslednyaya_versiya_0.pdf.Bello S.L., Serafino L., Bonali C., Terlizzi N., Fanizza C., Anecchino C., Lapaldula G. Incidence of influenza-like illness into a cohort of patients affected by chronic inflammatory rheumatism and treated with biological agents. Reumatismo. 2012;64(5):299–306. doi: 10.4081/reumatismo.2012.299.Bello S.L., Serafino L., Bonali C., Terlizzi N., Fanizza C., Anecchino C., Lapaldula G. Incidence of influenza-like illness into a cohort of patients affected by chronic inflammatory rheumatism and treated with biological agents. Reumatismo. 2012;64(5):299–306. doi: 10.4081/reumatismo.2012.299.Dirven L., Huizinga T.W., Allaart C.F. Risk factors for reported influenza and influenza-like symptoms in patients with rheumatoid arthritis. Scand J Rheumatol. 2012;41(5):359–365. doi: 10.3109/03009742.2012.670729.Dirven L., Huizinga T.W., Allaart C.F. Risk factors for reported influenza and influenza-like symptoms in patients with rheumatoid arthritis. Scand J Rheumatol. 2012;41(5):359–365. doi: 10.3109/03009742.2012.670729.Moiseev S., Avdeev S., Brovko M., Yavorovskiy A., Novikov P.I., Umbetova K. et al. Rheumatic diseases in intensive care unit patients with COVID-19. Ann Rheum Dis. 2020. doi: 10.1136/annrheumdis-2020-217676.Moiseev S., Avdeev S., Brovko M., Yavorovskiy A., Novikov P.I., Umbetova K. et al. Rheumatic diseases in intensive care unit patients with COVID-19. Ann Rheum Dis. 2020. doi: 10.1136/annrheumdis-2020-217676.Monti S., Balduzzi S., Delvino P., Bellis E., Quadrelli V.S., Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis. 2020;79(5):667–668. doi: 10.1136/annrheumdis-2020-217424.Monti S., Balduzzi S., Delvino P., Bellis E., Quadrelli V.S., Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis. 2020;79(5):667–668. doi: 10.1136/annrheumdis-2020-217424.Tomelleri A., Sartorelli S., Campochiaro C., Baldissera E.M., Dagna L. Impact of COVID-19 pandemic on patients with large-vessel vasculitis in Italy: a monocentric survey. Ann Rheum Dis. 2020;2020:annrheumdis- 2020-217600. doi: 10.1136/annrheumdis-2020-217600.Tomelleri A., Sartorelli S., Campochiaro C., Baldissera E.M., Dagna L. Impact of COVID-19 pandemic on patients with large-vessel vasculitis in Italy: a monocentric survey. Ann Rheum Dis. 2020;2020:annrheumdis- 2020-217600. doi: 10.1136/annrheumdis-2020-217600.Emmi G., Bettiol A., Mattioli I., Silvestri E., Di Scala G., Urban M.L. et al. SARS-CoV-2 infection among patients with systemic autoimmune diseases. Autoimmun Rev. 2020;2020:102575. doi: 10.1016/j.autrev.2020.102575.Emmi G., Bettiol A., Mattioli I., Silvestri E., Di Scala G., Urban M.L. et al. SARS-CoV-2 infection among patients with systemic autoimmune diseases. Autoimmun Rev. 2020;2020:102575. doi: 10.1016/j.autrev.2020.102575.Vincent M.J., Bergeron E., Benjannet S., Erickson B.R., Rollin P.E., Ksiazek T.G., Seidah N.G., Nichol S.T. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005;2:69. doi: 10.1186/1743-422X-2-69.Vincent M.J., Bergeron E., Benjannet S., Erickson B.R., Rollin P.E., Ksiazek T.G., Seidah N.G., Nichol S.T. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005;2:69. doi: 10.1186/1743-422X-2-69.Devaux C.A., Rolain J.-M., Colson P., Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? Int J Antimicrob Ag. 2020;55(5):105938. doi: 10.1016/j.ijantimicag.2020.105938.Devaux C.A., Rolain J.-M., Colson P., Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? Int J Antimicrob Ag. 2020;55(5):105938. doi: 10.1016/j.ijantimicag.2020.105938.Savarino A., Trani L.D., Donatelli I., Cauda R., Cassone A. New insights into the antiviral effects of chloroquine. Lancet Infect Dis. 2006;6(2):67–69. doi: 10.1016/S1473-3099(06)70361-9.Savarino A., Trani L.D., Donatelli I., Cauda R., Cassone A. New insights into the antiviral effects of chloroquine. Lancet Infect Dis. 2006;6(2):67–69. doi: 10.1016/S1473-3099(06)70361-9.Fantini J., Di Scala C., Chahinian H., Yahi N. Structural and molecular modelling studies reveal a new mechanism of action of chloroquine and hydroxychloroquine against SARS-CoV-2 infection. Int J Antimicrob Agents. 2020;55(5):105960. doi: 10.1016/j.ijantimicag.2020.105960.Fantini J., Di Scala C., Chahinian H., Yahi N. Structural and molecular modelling studies reveal a new mechanism of action of chloroquine and hydroxychloroquine against SARS-CoV-2 infection. Int J Antimicrob Agents. 2020;55(5):105960. doi: 10.1016/j.ijantimicag.2020.105960.Chen Z., Hu J., Zhang Z., Jiang S., Han S., Yan D. et al. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. MedRxiv. 2020. doi: 10.1101/2020.03.22.20040758.Chen Z., Hu J., Zhang Z., Jiang S., Han S., Yan D. et al. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. MedRxiv. 2020. doi: 10.1101/2020.03.22.20040758.Gao J., Tian Z., Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72–73. doi: 10.5582/bst.2020.01047.Gao J., Tian Z., Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72–73. doi: 10.5582/bst.2020.01047.Yao X., Ye F., Zhang M., Cui C., Huang B., Niu P. et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020;2020:ciaa237. doi: 10.1093/cid/ciaa237.Yao X., Ye F., Zhang M., Cui C., Huang B., Niu P. et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020;2020:ciaa237. doi: 10.1093/cid/ciaa237.Cortegiani A., Ingoglia G., Ippolito M., Giarratano A., Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020;57:279–283. doi: 10.1016/j.jcrc.2020.03.005.Cortegiani A., Ingoglia G., Ippolito M., Giarratano A., Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020;57:279–283. doi: 10.1016/j.jcrc.2020.03.005.Ferner R.E., Aronson J.K. Chloroquine and hydroxychloroquine in covid-19. BMJ. 2020;369:m1432. doi: 10.1136/bmj.m1432.Ferner R.E., Aronson J.K. Chloroquine and hydroxychloroquine in covid-19. BMJ. 2020;369:m1432. doi: 10.1136/bmj.m1432.Graef E.R., Liew J.W., Putman M.S., Simard J.F., Sirotich E., Berenbaum F. et al. Festina lente: hydroxychloroquine, COVID-19 and the role of the rheumatologist. Ann Rheum Dis. 2020;79(6):734–736. doi: 10.1136/annrheumdis-2020-217480.Graef E.R., Liew J.W., Putman M.S., Simard J.F., Sirotich E., Berenbaum F. et al. Festina lente: hydroxychloroquine, COVID-19 and the role of the rheumatologist. Ann Rheum Dis. 2020;79(6):734–736. doi: 10.1136/annrheumdis-2020-217480.Perinel S., Launay M., Botelho-Nevers É., Diconne E., Louf-Durier A., Lachand R. et al. Towards Optimization of Hydroxychloroquine Dosing in Intensive Care Unit COVID-19 Patients. Clin Infect Dis. 2020;ciaa394. doi: 10.1093/cid/ciaa394.Perinel S., Launay M., Botelho-Nevers É., Diconne E., Louf-Durier A., Lachand R. et al. Towards Optimization of Hydroxychloroquine Dosing in Intensive Care Unit COVID-19 Patients. Clin Infect Dis. 2020;ciaa394. doi: 10.1093/cid/ciaa394.Monti S., Montecucco C. Can hydroxychloroquine protect patients with rheumatic diseases from COVID-19? Response to: ‘Does hydroxychloroquine prevent the transmission of COVID-19?’ by Heldwein and Calado and ‘SLE, hydroxychloroquine and no SLE patients with COVID-19: a comment’ by Joob and Wiwanitkit. Ann Rheum Dis. 2020;79(6):e62. doi: 10.1136/annrheumdis-2020-217524.Monti S., Montecucco C. Can hydroxychloroquine protect patients with rheumatic diseases from COVID-19? Response to: ‘Does hydroxychloroquine prevent the transmission of COVID-19?’ by Heldwein and Calado and ‘SLE, hydroxychloroquine and no SLE patients with COVID-19: a comment’ by Joob and Wiwanitkit. Ann Rheum Dis. 2020;79(6):e62. doi: 10.1136/annrheumdis-2020-217524.Mehra M.R., Desai S.S., Ruschitzka F., Patel A.N. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020;S0140-6736(20)31180-6. doi: 10.1016/S0140-6736(20)31180-6.Mehra M.R., Desai S.S., Ruschitzka F., Patel A.N. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020;S0140-6736(20)31180-6. doi: 10.1016/S0140-6736(20)31180-6.Mathian A., Mahevas M., Rohmer J., Roumer M., Cohen-Aubart F., Amador- Borrero B. et al. Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under longterm treatment with hydroxychloroquine. Ann Rheum Dis. 2020;79(6):837–839. doi: 10.1136/annrheumdis-2020-217566.Mathian A., Mahevas M., Rohmer J., Roumer M., Cohen-Aubart F., Amador- Borrero B. et al. Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under longterm treatment with hydroxychloroquine. Ann Rheum Dis. 2020;79(6):837–839. doi: 10.1136/annrheumdis-2020-217566.Konig M.F., Kim A.H., Scheetz M.H., Graef E.G., Liew J.W., Simard J. et al. Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19. Ann Rheum Dis. 2020;annrheumdis-2020-217690. doi: 10.1136/annrheumdis-2020-217690.Konig M.F., Kim A.H., Scheetz M.H., Graef E.G., Liew J.W., Simard J. et al. Baseline use of hydroxychloroquine in systemic lupus erythematosus does not preclude SARS-CoV-2 infection and severe COVID-19. Ann Rheum Dis. 2020;annrheumdis-2020-217690. doi: 10.1136/annrheumdis-2020-217690.Shah S., Das S., Jain A., Misra D.P., Negi V.S. A systematic review of the prophylactic role of chloroquine and hydroxychloroquine in Coronavirus Disease-19 (COVID-19). Int J Rheum Dis. 2020;23(5):613–619. doi: 10.1111/1756-185X.13842.Shah S., Das S., Jain A., Misra D.P., Negi V.S. A systematic review of the prophylactic role of chloroquine and hydroxychloroquine in Coronavirus Disease-19 (COVID-19). Int J Rheum Dis. 2020;23(5):613–619. doi: 10.1111/1756-185X.13842.Shakoory B., Carcillo J.A., Chatham W.W., Amdur R.L., Zhao H., Dinarello C.A. et al. Interleukin-1 Receptor Blockade Is Associated with Reduced Mortality in Sepsis Patients with Features of Macrophage Activation Syndrome: Reanalysis of a Prior Phase III Trial. Crit Care Med. 2016;44(2):275–281. doi: 10.1097/CCM.0000000000001402.Shakoory B., Carcillo J.A., Chatham W.W., Amdur R.L., Zhao H., Dinarello C.A. et al. Interleukin-1 Receptor Blockade Is Associated with Reduced Mortality in Sepsis Patients with Features of Macrophage Activation Syndrome: Reanalysis of a Prior Phase III Trial. Crit Care Med. 2016;44(2):275–281. doi: 10.1097/CCM.0000000000001402.Aouba A., Baldolli A., Geffray L., Verdon R., Bergot E., Martin-Silva N., Justet A. Targeting the inflammatory cascade with anakinra in moderate to severe COVID-19 pneumonia: case series. Ann Rheum Dis. 2020;annrheumdis-2020-217706. doi: 10.1136/annrheumdis-2020-217706.Aouba A., Baldolli A., Geffray L., Verdon R., Bergot E., Martin-Silva N., Justet A. Targeting the inflammatory cascade with anakinra in moderate to severe COVID-19 pneumonia: case series. Ann Rheum Dis. 2020;annrheumdis-2020-217706. doi: 10.1136/annrheumdis-2020-217706.Xu X., Han M., Li T., Sun W., Wang D., Fu B. et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA. 2020;117(20):10970–10975. doi: 10.1073/pnas.2005615117.Xu X., Han M., Li T., Sun W., Wang D., Fu B. et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA. 2020;117(20):10970–10975. doi: 10.1073/pnas.2005615117.Toniati P., Piva S., Cattalini M., Garrafa E., Regola F., Castelli F. et al. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020;102568. doi: 10.1016/j.autrev.2020.102568.Toniati P., Piva S., Cattalini M., Garrafa E., Regola F., Castelli F. et al. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020;102568. doi: 10.1016/j.autrev.2020.102568.Hoffmann M., Kleine-Weber H., Schroeder S., Krüger N., Herrler T., Erichsen S. et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271–280.e8. doi: 10.1016/j.cell.2020.02.052.Hoffmann M., Kleine-Weber H., Schroeder S., Krüger N., Herrler T., Erichsen S. et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271–280.e8. doi: 10.1016/j.cell.2020.02.052.Lu R., Zhao X., Li J., Niu P., Yang B., Wu H. et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. doi: 10.1016/S0140-6736(20)30251-8.Lu R., Zhao X., Li J., Niu P., Yang B., Wu H. et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–574. doi: 10.1016/S0140-6736(20)30251-8.Bekerman E., Neveu G., Shulla A., Brannan J., Pu S.-Y., Wang S. et al. Anticancer kinase inhibitors impair intracellular viral trafficking and exert broad-spectrum antiviral effects. J Clin Invest. 2017;127(4):1338–1352. doi: 10.1172/JCI89857.Bekerman E., Neveu G., Shulla A., Brannan J., Pu S.-Y., Wang S. et al. Anticancer kinase inhibitors impair intracellular viral trafficking and exert broad-spectrum antiviral effects. J Clin Invest. 2017;127(4):1338–1352. doi: 10.1172/JCI89857.Richardson P., Griffin I., Tucker C., Smith D., Oechsle O., Phelan A., Stebbing J. Baricitinib as potential treatment for 2019-nCoV acute respiratory disease. Lancet. 2020;395(10223):e30–e31. doi: 10.1016/S0140-6736(20)30304-4.Richardson P., Griffin I., Tucker C., Smith D., Oechsle O., Phelan A., Stebbing J. Baricitinib as potential treatment for 2019-nCoV acute respiratory disease. Lancet. 2020;395(10223):e30–e31. doi: 10.1016/S0140-6736(20)30304-4.Kelesidis T., Mastoris I., Metsini A., Tsiodras S. How to approach and treat viral infections in ICU patients. BMC Infect Dis. 2014;14:321. doi: 10.1186/1471-2334-14-321.Kelesidis T., Mastoris I., Metsini A., Tsiodras S. How to approach and treat viral infections in ICU patients. BMC Infect Dis. 2014;14:321. doi: 10.1186/1471-2334-14-321.Zhou F., Yu T., Du R., Fun G., Liu Y., Liu Z. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3.Zhou F., Yu T., Du R., Fun G., Liu Y., Liu Z. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3.Cantini F., Niccoli L., Matarrese D., Nicastri E., Strobbione P., Goletti D. Baricitinib therapy in COVID-19: A pilot study on safety and clinical impact. J Infect. 2020;S0163-4453(20)30228-0. doi: 10.1016/j.jinf.2020.04.017.Cantini F., Niccoli L., Matarrese D., Nicastri E., Strobbione P., Goletti D. Baricitinib therapy in COVID-19: A pilot study on safety and clinical impact. J Infect. 2020;S0163-4453(20)30228-0. doi: 10.1016/j.jinf.2020.04.017.Praveen D., Puvvada R.C., Aanandhi M. Janus kinase inhibitor baricitinib is not an ideal option for management of COVID-19. Int J Antimicrob Agents. 2020;55(5):105967. doi: 10.1016/j.ijantimicag.2020.105967.Praveen D., Puvvada R.C., Aanandhi M. Janus kinase inhibitor baricitinib is not an ideal option for management of COVID-19. Int J Antimicrob Agents. 2020;55(5):105967. doi: 10.1016/j.ijantimicag.2020.105967.Favalli E.G., Biggioggero M., Maioli G., Caporali R. Baricitinib for COVID-19: a suitable treatment? Lancet Infect Dis. 2020;S1473-3099(20)30262-0. doi: 10.1016/S1473-3099(20)30262-0.Favalli E.G., Biggioggero M., Maioli G., Caporali R. Baricitinib for COVID-19: a suitable treatment? Lancet Infect Dis. 2020;S1473-3099(20)30262-0. doi: 10.1016/S1473-3099(20)30262-0.Zhang J., Zeng H., Gu J., Li H., Zheng L., Zou Q. Progress and Prospects on Vaccine Development against SARS-CoV-2. Vaccines (Basel). 2020;8(2):E153. doi: 10.3390/vaccines8020153.Zhang J., Zeng H., Gu J., Li H., Zheng L., Zou Q. Progress and Prospects on Vaccine Development against SARS-CoV-2. Vaccines (Basel). 2020;8(2):E153. doi: 10.3390/vaccines8020153.Furer V., Rondaan C., Heijstek M.W., Agmon-Levin N., van Assen S., Bijl M. et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(1):39–52. doi: 10.1136/annrheumdis-2019-215882.Furer V., Rondaan C., Heijstek M.W., Agmon-Levin N., van Assen S., Bijl M. et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79(1):39–52. doi: 10.1136/annrheumdis-2019-215882.

The authors declare that there are no conflicts of interest present.