Traitements systémiques et risque infectieux dans le contexte de pandémie COVID-19: Systemic treatments and infection risk in the context of the COVID-19 pandemic

Coronavirus pandemic 2019 (COVID-19, Coronavirus Disease 2019) is a serious global health threat caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with more than 219 million cases confirmed to this day. While the majority of patients present with mild flu-like symptoms, some patients will develop severe forms, often associated with acute lung disease. This lung infection may be complicated by acute respiratory distress syndrome or multivisceral failure with a high risk of death. Mortality in patients with COVID-19 is strongly related to age, smoking, and the presence of comorbidities such as diabetes, hypertension, obesity, and chronic cardiopulmonary disease. Systemic therapies that target B and T cells and their regulatory pathways may also be responsible for an increased risk of severe forms and mortality in COVID-19 patients. The systemic treatments associated with the highest risk are rituximab and most of the immunosuppressants (including mycophenolate mofetil and long-term corticosteroid therapy > 10 mg/d). A recent study also suggests an increased risk when patients are treated with JAK inhibitors. Biologic agents targeting cytokines, particularly those prescribed for psoriasis, are not associated with an increased risk of severe COVID-19 and their prescription should not be delayed in the context of the COVID-19 pandemic. © 2021 Elsevier Masson SAS. All rights reserved.