Optimal strategies need to be developed for patients relying on rituximab in a world where COVID-19 becomes endemic, two Australian rheumatologists warn.

Just as rituximab is being shown to have potential utility across multiple diseases, evidence is accumulating that it’s associated with worsening severity of COVID-19 illness and increased deaths, they write in an editorial in The Lancet Rheumatology.

Their commentary accompanies a large US study on the effect of a broad range of immunosuppressant agents — including rheumatological biologics, cancer therapies and oral glucocorticoids — on patients admitted to hospital for COVID-19.

The research compares 13,000 patients using such agents with 29,000 matched patients not using them, finding that, overall, those on immunosuppressants had an advantage, with an 11% reduced risk of needing invasive ventilation.