ERN ReCONNET points to consider for treating patients living with autoimmune rheumatic diseases with antiviral therapies and anti-SARS-CoV-2 antibody products

Recent studies have shown that people who are immunocompromised may in- advertently play a role in spurring the mutations of the virus that create new variants. This is because some immuno- compromised individuals remain at risk of getting COVID-19 despite vaccina- tion, experience more severe disease, are susceptible to being chronically in- fected and remain contagious for longer if they become infected and considering that immunocompromised individuals represent approximately 2% of the over- all population, this aspect should be carefully considered. So far, some autoimmune rheumatic disease (ARD) patients with COVID-19 have been treated with antiviral thera- pies or anti-SARS-CoV-2 antibody prod- ucts. However, there is no homogeneous approach to these treatment strategies. This issue was addressed within the Eu- ropean Reference Network (ERN) on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ReCON- NET) in a discussion among experts and patient’s representatives in the context of the rare and complex connective tissue diseases (rCTDs) covered by the Net- work. ERN ReCONNET is one of the 24 ERNs launched by the European Com- mission in 2017 with the aim of tackling low prevalence and rare diseases that require highly specialised treatment and promoting concentration of knowledge and resources through virtual networks involving healthcare providers (HCPs) across the European Union (EU). Considering the urgent need to provide guidance not only to the rCTDs commu- nity, but also to the whole ARDs com- munity, a multidisciplinary Task Force, including expert clinicians and Euro- pean Patient Advocacy Group (ePAG) Advocates, was created in the frame- work of ERN ReCONNET with the aim of developing overarching principles (OP) and points-to-consider (PtC) on a homogenous approach to treat immuno- compromised patients with ARDs (with a particular focus on CTDs) affected by COVID-19 using antiviral therapies and anti-SARS-CoV-2 antibody prod- ucts. The present work reports the final OP and PtC agreed by the Task Force. • What is already known about this subject? Immunocompromised individuals re- main at risk of getting COVID-19 de- spite vaccination, may be susceptible to being chronically infected, and remain contagious for longer if they become infected. • What does this study add? The present overarching principles (OP) and points-to-consider (PtC) aim at facilitating a homogenous approach to treat immunocompromised patients with ARDs affected by COVID-19 us- ing antiviral therapies and anti-SARS- CoV-2 antibody products. • How might this impact clinical practice? The PtC highlight how booster and pre-exposure treatment can be con- sidered complementary, as well as the need to early use antiviral agents and ant- SARS-CoV-2 antibody products in most fragile patients.