Introduction: Management of Covid-19 immunocompromised patients has challenged healthcare worldwide. Despite high vaccination rates, multiple breakthrough cases required hospitalization. One of the factors leading to immunosuppression is treatment with monoclonal antibodies against the CD20 molecule (e.g. rituximab) now widely used in the treatment of diseases such as autoimmune diseases and malignancies.

Aim: To present the experience of a Respiratory department in the acute COVID-19 infection in immunocompromised patients on anti-CD20 therapy.

Methodology: Prospective observational study over 18 months. Data was recorded on the cause of immunosuppression, vaccination status, clinical severity, treatment and follow-up.

Results: Over 6 months, 65 patients with primary/secondary immunosuppression in a total of 412 Covid-19 patients (44% patients with autoimmune disease, 26% with haematological malignancy, 13% with solid organ malignancy, 7% with interstitial lung disease, 4% with primary immunodeficiency, 3% with severe asthma) were identified with a length of stay of 10 days. 18 had received an anti-CD20 agent, all but one were fully vaccinated, 1 in 3 had a history of previous hospitalization due to a COVID-19 infection and 1 in 5 was hospitalized for more than 15 days. Patients were managed successfully with antiviral medication for longer than non-immunocompromised ones on the ward and no escalation of care was required.

Conclusion: Patients on anti-CD20 agents showed prolonged viremia, persistent fever, high risk for clinical deterioration and longer hospitalization. The ever-increasing number of these patients dicates a need for tailoring of treatment and constantly updated training.