key: cord-0767290-83v7xm1u
authors: Felten, Renaud; Chatelus, Emmanuel; Arnaud, Laurent
title: How and why rheumatologists are relevant to COVID-19?
date: 2020-04-30
journal: Joint Bone Spine
DOI: 10.1016/j.jbspin.2020.04.006
sha: 867edc264960f3d96d9496ad121b2451c8b1c5e3
doc_id: 767290
cord_uid: 83v7xm1u

nan

The unprecedented health crisis at COVID-19 mobilized all of our medical forces, with emergency physicians, intensivists, infectious diseases specialists and internists at the forefront, in which rheumatologists had to and were able to find their place.

The current state shows that old and new perspectives are opening up for anti-rheumatic drugs in the treatment of this pandemic (1, 2) . A search on clinicaltrials.gov conducted on April 23, 2020 identified 363 phase I to IV interventional clinical trials for the Management of the COVID-19 Pandemic (figure 1), involving a total of 170 treatments. Importantly, 143 trials (39%) involve treatments used daily by rheumatologists: 10 for NSAIDs and corticosteroids, 133 for DMARDs (88 hydroxychloroquine, 14 chloroquine, 14 tocilizumab, 8 sarilumab, 6 colchicine, 4 anakinra, 3 baricitinib, 1 tofacitinib, 1 methotrexate, some trials testing several molecules at the same time in different arms). In addition, 46 trials (11%) are evaluating targeted therapies that are well known to rheumatologists because they are used in other indications (cancer immunotherapy or conventional immunosuppressants, n=9) or are under development in inflammatory diseases (n=37). Rheumatologists are thus experienced with drugs involved in more than 50% of the COVID-19 trials. Trials of specific anti-viral treatments (n=30) or evaluating vaccines (n=14) account for just over 10% of the trials (n=44). Fourty trials evaluated cellular therapies (n=22) or plasma transfusions from immunized patients (n=18). Twenty-one trials are evaluating oxygen therapy modalities or inhaled treatments. Seventeen trials are evaluating vitamin or dietary supplements. Finally, 52 are evaluating a wide variety of treatments, including angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, anti-aggregants, anticoagulants, antibiotics and other treatments or support therapy.

The covid-nma.com website is a quick and useful tool for all clinicians looking for quick information on current research and those with published results. It is a "living mapping of ongoing research". On this site on April 23, 2020, 339 Randomized Trials (excluding Traditional Chinese medicine trials) including 163 RCTs currently recruiting were identified.

At the onset of this pandemic, we feared for our patients with chronic inflammatory diseases treated with immunosuppressive drugs. The lack of data in this population in China raised concerns about susceptibility to severe forms in our patients. More recent European data, now suggest that they should not be at such a higher risk (3) . Of note, these reassuring data are subject to bias because these patients may have been confined earlier, more strictly and may protect themselves better than the general population. It is therefore our duty to continue to register these patients by describing both benign are severe forms in order to build a reliable database about this potentially at-risk population. Although discontinuing immunosuppressive therapy in the event of infection is logical and commonly done by patients themselves, the question of restarting it once the COVID-19 infection has been cured remains an unknown. Is there not a risk of viral reactivation by inhibiting the anti-viral response? Therefore, barrier measures should be emphasized as much as possible. Our patients must also be informed of the clinical signs that justify medical consultation (fever and respiratory manifestations). It is therefore important that they can easily contact their rheumatologist (4).

Our rheumatologist experience in clinical trial design, the inclusion of patients in these trials and our knowledge of many of those potential treatments have allowed us to make ourselves 

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Implications of COVID-19 for the management of patients with inflammatory rheumatic diseases