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Song H, Zhang Y, Chen Y, Zhang M, Gao F, Zhao C. Association between COVID-19 infection and uveitis flare in patients with Behcet's disease, a retrospective multicenter cohort study. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06536-4. [PMID: 39141118 DOI: 10.1007/s00417-024-06536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/18/2024] [Accepted: 05/27/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE To explore if COVID-19 infection and its subsequent immunosuppressant adjustment as well as previous vaccination status are associated with higher risks of uveitis flare in patients with Behcet's disease. METHODS This retrospective multicenter cohort study was conducted in January 2023 among patients with Behcet's uveitis, during the second wave of the COVID-19 pandemic in China, with an anticipated sample size of 250. The primary objective was to examine the association between COVID-19 infection and the occurrence of uveitis flare. The potential impact of other exposures, including the patient's vaccination status and treatment adjustments to the risk of uveitis flare and the course of COVID-19 infection were also analyzed. RESULTS 207 patients with COVID-19 infection and 47 patients without COVID-19 infection were included. A total of 127 uveitis flares occurred in the observational period (14.29 events per 100 person-month). COVID-19 infection was found to be significantly associated with a higher rate of uveitis flare (adjusted rate ratio = 4.8, 95% CI 3.7 to 6.3, P < 0.001). However, neither systemic immunosuppressive adjustment nor COVID-19 vaccination status showed a significant association with uveitis flare or the course of COVID-19 infection. CONCLUSIONS This study provides evidence of an association between COVID-19 infection and an increased risk of uveitis flare in patients with Behcet's disease. However, there was no significant evidence to support that baseline immunosuppressive therapy regimens, treatment adjustment after COVID-19 infection, or vaccination status were associated with higher risks of uveitis flare or prolonged COVID-19 course.
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Affiliation(s)
- Hang Song
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Chen
- Department of Ophthalmology, Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated People's Hospital of Northwest University, Xi'an, Shaanxi Province, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fei Gao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Embaby A, Maged LA, Abdel-Hamid HM, El Hadidi KT. Factors associated with severe infection in rheumatoid arthritis patients: lessons learned from the COVID-19 pandemic. Infection 2024; 52:1337-1345. [PMID: 38381306 PMCID: PMC11289044 DOI: 10.1007/s15010-024-02187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE This aimed to identify the factors associated with severe/critical coronavirus disease 2019 (COVID-19) infection in rheumatoid arthritis (RA) patients. METHODS Two-hundred RA patients diagnosed according to the American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) classification criteria with proven COVID-19 infection were recruited and categorized according to the world health organization (WHO) COVID-19 severity grading into 2 groups: patients with mild/moderate COVID-19 (n = 164) and patients with severe/critical COVID-19 (n = 36). Comparison between both groups was done to identify the risk factors associated with severe/critical infection. Incidence of RA disease activity flare defined as increase in clinical disease activity index (CDAI) more than 10 points following infection was calculated. RESULTS Multivariate analysis identified history of previous serious infection, age > 60 years, and diabetes as factors positively associated, whereas COVID-19 vaccination was negatively associated with severe/critical infection. Following COVID-19 infection, the number of patients with severe/critical COVID-19 who had high RA disease activity and the incidence of flares was significantly higher in comparison to patients with mild/moderate COVID-19 (P < 0.001 and 0.003; respectively). CONCLUSION Age > 60 years, diabetes, and history of previous serious infections are risk factors for severe/critical COVID-19, while vaccination has a protective role in RA patients. Infection particularly when severe is associated with risk of disease flare.
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Affiliation(s)
- Aya Embaby
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lobna A Maged
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Hoda M Abdel-Hamid
- Chest Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled T El Hadidi
- Rheumatology Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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De Grazia S, Pollicino F, Giannettino C, Errera CM, Veronese N, Giammanco GM, Cacioppo F, Sanfilippo GL, Barbagallo M. Factors Associated with Prolonged SARS-CoV-2 Viral Positivity in an Italian Cohort of Hospitalized Patients. Diseases 2024; 12:138. [PMID: 39057109 PMCID: PMC11275323 DOI: 10.3390/diseases12070138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Clinical or microbiological factors potentially associated with prolonged COVID-19 PCR positivity are still poorly underexplored, but they could be of importance for public-health and clinical reasons. The objective of our analysis is to explore demographic, clinical, and microbiological factors potentially associated with a prolonged positivity to SARS-CoV-2 among 222 hospitalized patients. Prolonged detection positivity for SARS-CoV-2 RNA in swap samples, defined as positivity more than 21 days, was the outcome of interest. The 56 cases with a prolonged positivity to SARS-CoV-2 were matched for age and sex with 156 controls. The cases reported a significantly higher presence of diabetes mellitus, autoimmune diseases, chronic kidney diseases, and acute coronary syndrome. Moreover, the viral load was significantly higher in a period of prolonged positivity compared to a normal period. In the multivariable analysis, the presence of autoimmune diseases and chronic kidney disease were significantly associated with an increased risk of prolonged positivity as well as medium viral load or high viral load, i.e., low Ct value ≤ 30 indicating high viral load. The results of this study confirmed that in a large population of hospitalized patients with COVID-19 manifestations, the prolonged positivity of SARS-CoV-2 detection with nasopharyngeal swab was mainly related to autoimmune diseases, chronic kidney disease, and to baseline viral load.
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Affiliation(s)
| | | | | | | | - Nicola Veronese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (S.D.G.); (F.P.); (C.G.); (C.M.E.); (G.M.G.); (F.C.); (G.L.S.); (M.B.)
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Kapten K, Orczyk K, Smolewska E. Application of Interferon-γ Release Assay in the Assessment of T-Cell Immunity to SARS-CoV-2 Antigens in the Cohort of Pediatric Patients with Juvenile Idiopathic Arthritis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:736. [PMID: 38929315 PMCID: PMC11201484 DOI: 10.3390/children11060736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
Background: an accurate assessment of the immunity against SARS-CoV-2 can facilitate a better understanding and management of not only the recent coronavirus but similar pathogens as well. Objective: the aim of this study was to evaluate T-cell immunity with reference to antibody titers in a group of pediatric patients with autoimmune arthritides utilizing the widely known Interferon-γ Release Assay (IGRA). Materials and Methods: This study was conducted in the cohort of 55 children suffering from Juvenile Idiopathic Arthritis (JIA). This research analyzed the SARS-CoV-2 T-cell response measured by a specific quantitative IGRA, followed by a serological ELISA test measuring the presence and quantity of IgG, IgM, and IgA antibodies in serum. Results: The cellular response to SARS-CoV-2 measured by the IGRA test significantly correlated with the antibody titers, IgA (p < 0.00003, R = 0.537), IgG (p < 0.0001, R = 0.668), and IgG nucleocapsid protein (NCP) (p < 0.003, R = 0.0399), with no correlation with IgM levels. The antibody levels in patients receiving biological agents were significantly lower compared to the rest of the cohort (p = 0.0369), while traditional disease-modifying antirheumatic drugs had no such effect. Limitations: the main limitation of the research is the small sample size, mostly due to the specific cohort of patients and the lack of a healthy control. Conclusions: IGRA appears to be a viable tool in the accurate evaluation of T-cell responses to SARS-CoV-2, and serodiagnostics alone is not always sufficient in the assessment of immune responses.
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Affiliation(s)
- Katarzyna Kapten
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, 91-738 Lodz, Poland;
| | - Krzysztof Orczyk
- Department of Pediatric Infectious Diseases, Medical University of Lodz, 91-347 Lodz, Poland;
| | - Elzbieta Smolewska
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, 91-738 Lodz, Poland;
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Kim AHJ. Additional SARS-CoV-2 vaccine doses: a little is better than none. THE LANCET. RHEUMATOLOGY 2024; 6:e330-e331. [PMID: 38734020 DOI: 10.1016/s2665-9913(24)00119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO 63110, USA.
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Safar Alsofyani I, Samman BS, Alhubayshi SS, Ellahi AT, Alsaedi AB, Almansour M. Impact of COVID-19 Pandemic on Patients With Rheumatic Diseases in Medina, Saudi Arabia: An Observational Cross-Sectional Study. Cureus 2024; 16:e60128. [PMID: 38864060 PMCID: PMC11165667 DOI: 10.7759/cureus.60128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION The Coronavirus disease of 2019 (COVID-19) pandemic undoubtedly ranks among the most health-impacting pandemics throughout medical history. Although the COVID-19 global public health emergency has ended, lessons need to be learned to be more ready to face similar pandemics in the future. Few studies in Saudi Arabia discuss the impact of the COVID-19 pandemic on autoimmune rheumatic disease (AIRD) patients. Thus, this study was conducted to elaborate on the effects of the COVID-19 pandemic on AIRD patients and rheumatology practices in Saudi Arabia. Methods: This observational cross-sectional study was conducted among patients aged over 14 with AIRD using a pre-designed validated survey questionnaire. Data were collected from AIRD patients who were following up between November 2021 to April 2022 at the Rheumatology Clinic of King Fahad General Hospital in Madinah City, Saudi Arabia. This center was chosen as being the main hospital in the city following patients of AIRD. RESULTS A total of 324 patients were included in our study, with the majority (n=264, 81.5%) being females. The mean age was 44.42±14.4 years. Clinical data revealed that 115 (35.5%) of our patients experienced mild COVID-19 infection, 19 (5.9%) suffered from respiratory insufficiency, and seven (2.2%) required admission to the intensive care unit (ICU). Non-compliance to medication was recorded at 25.2%. There were 115 (35.5%) patients who had an AIRD flare that was significantly higher among those who were not adherent to the medications (p<0.001). Disease flare was also significantly seen among patients who were not on prednisone or were on low doses of prednisone (p<0.001). The majority (n=33, 97.1%) of the 34 infected patients who had an AIRD flare had their flare-up at the same time as their COVID-19 infection (p<0.001). COVID-19 vaccination rate was 87.7% (n=284). The most common reason for non-vaccination in 40 (12.3%) patients was the patients' concern about disease flare-ups by the vaccine or interference of the vaccine with their medication (n=16, 4.9%). CONCLUSION Our study showed a 35.5% (n=115) COVID-19 infection rate. The majority of our AIRD patients sustained minor infections that did not require hospitalization or ICU admission. The majority of the patients who underwent a severe COVID-19 infection course were not on prednisolone or were on low-dose prednisone. Due to COVID-19 restrictions and drug shortages, one in four patients (25.3%) stopped taking their medications and was significantly found to have a high prevalence of underlying AIRD flare. Despite the high vaccination rate, disease flare was the biggest concern for those who were not immunized. Although the COVID-19 pandemic has ended, doctors should be aware of risk factors associated with severe AIRD outcomes that should be balanced based on the infection severity, underlying disease flares, and patient-centered education about medication adherence and vaccination.
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Affiliation(s)
| | - Basim S Samman
- Internal Medicine, Ministry of National Guard - Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Medina, SAU
| | | | - Amjad T Ellahi
- Internal Medicine, King Fahad General Hospital, Medina, SAU
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Maheshwari R, Sharma M, Chidrawar VR. Niosomes based formulation containing tenoxicam: A newer solution for the rheumatic diseases. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:473-482. [PMID: 37923009 DOI: 10.1016/j.pharma.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This investigation aimed to explore the potential of non-ionic surfactant based niosomal vesicles encapsulating tenoxicam (TN; anti-rheumatic drug) for the treatment of rheumatic diseases. MATERIAL AND METHODS Mechanical dispersion technique with controlled pressure was employed to prepare different niosomal formulations. The effects of different ratios of surfactant (span-60), lipid, and sodium deoxycholate on noisome's physicochemical properties have been examined. Moreover, inhibition of TNF-α in lipopolysaccharide-activated cultured Human leukemia monocytic (THP-1) cells were demonstrated to assess the in vitro inflammation profile. Finally, the optimized niosomal formulation (TN3) was prepared in gel matrix consist of carbopol 934 (termed as TN34) and stability was also tested at 4±2 ̊C, 25±2 ̊C, 37±2 ̊C and 45±2 ̊C for 6 months. RESULTS The optimized niosomal formulation exhibited a small vesicle size (165±14nm) and high drug encapsulation (79.64±1.5%). Niosomal gel formulation TN34 showed pH (6.7), viscosity (6810±3.34 cps), spreadability (19.11±1.87gm.cm/sec) and also displayed sustained release pattern of drug release (98.16±0.07% TN released from gel matrix in 24h) in vitro release study. TN34 exhibited substantial anti-inflammatory response, with ∼75% inhibition of TNF-α in 48h. Stability investigation revealed that refrigerator temperature is most suitable for the storage of niosomal gel. CONCLUSION Transdermal niosomal formulation displayed promising potential in the treatment of rheumatic diseases.
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Affiliation(s)
- Rahul Maheshwari
- School of Pharmacy and Technology Management, SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed-to-University, Green Industrial Park, TSIIC, Jadcherla-509301, Hyderabad, India.
| | - Mayank Sharma
- School of Pharmacy and Technology Management, SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed-to-University, Shirpur-425405, MH, India
| | - Vijay R Chidrawar
- School of Pharmacy and Technology Management, SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed-to-University, Green Industrial Park, TSIIC, Jadcherla-509301, Hyderabad, India
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Nakamura N, Kobashi Y, Kim KS, Park H, Tani Y, Shimazu Y, Zhao T, Nishikawa Y, Omata F, Kawashima M, Yoshida M, Abe T, Saito Y, Senoo Y, Nonaka S, Takita M, Yamamoto C, Kawamura T, Sugiyama A, Nakayama A, Kaneko Y, Jeong YD, Tatematsu D, Akao M, Sato Y, Iwanami S, Fujita Y, Wakui M, Aihara K, Kodama T, Shibuya K, Iwami S, Tsubokura M. Modeling and predicting individual variation in COVID-19 vaccine-elicited antibody response in the general population. PLOS DIGITAL HEALTH 2024; 3:e0000497. [PMID: 38701055 PMCID: PMC11068210 DOI: 10.1371/journal.pdig.0000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/14/2024] [Indexed: 05/05/2024]
Abstract
As we learned during the COVID-19 pandemic, vaccines are one of the most important tools in infectious disease control. To date, an unprecedentedly large volume of high-quality data on COVID-19 vaccinations have been accumulated. For preparedness in future pandemics beyond COVID-19, these valuable datasets should be analyzed to best shape an effective vaccination strategy. We are collecting longitudinal data from a community-based cohort in Fukushima, Japan, that consists of 2,407 individuals who underwent serum sampling two or three times after a two-dose vaccination with either BNT162b2 or mRNA-1273. Using the individually reconstructed time courses of the vaccine-elicited antibody response based on mathematical modeling, we first identified basic demographic and health information that contributed to the main features of the antibody dynamics, i.e., the peak, the duration, and the area under the curve. We showed that these three features of antibody dynamics were partially explained by underlying medical conditions, adverse reactions to vaccinations, and medications, consistent with the findings of previous studies. We then applied to these factors a recently proposed computational method to optimally fit an "antibody score", which resulted in an integer-based score that can be used as a basis for identifying individuals with higher or lower antibody titers from basic demographic and health information. The score can be easily calculated by individuals themselves or by medical practitioners. Although the sensitivity of this score is currently not very high, in the future, as more data become available, it has the potential to identify vulnerable populations and encourage them to get booster vaccinations. Our mathematical model can be extended to any kind of vaccination and therefore can form a basis for policy decisions regarding the distribution of booster vaccines to strengthen immunity in future pandemics.
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Affiliation(s)
- Naotoshi Nakamura
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Yurie Kobashi
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima, Japan
| | - Kwang Su Kim
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
- Department of Science System Simulation, Pukyong National University, Busan, South Korea
- Department of Mathematics, Pusan National University, Busan, South Korea
| | - Hyeongki Park
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Yuta Tani
- Medical Governance Research Institute, Tokyo, Japan
| | - Yuzo Shimazu
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshitaka Nishikawa
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima, Japan
| | - Fumiya Omata
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima, Japan
| | - Moe Kawashima
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Toshiki Abe
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Yuki Senoo
- Medical Governance Research Institute, Tokyo, Japan
| | - Saori Nonaka
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Morihito Takita
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Chika Yamamoto
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takeshi Kawamura
- Proteomics Laboratory, Isotope Science Center, The University of Tokyo, Tokyo, Japan
- Laboratory for Systems Biology and Medicine, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Akira Sugiyama
- Proteomics Laboratory, Isotope Science Center, The University of Tokyo, Tokyo, Japan
| | - Aya Nakayama
- Proteomics Laboratory, Isotope Science Center, The University of Tokyo, Tokyo, Japan
| | - Yudai Kaneko
- Laboratory for Systems Biology and Medicine, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
- Medical & Biological Laboratories Co., Ltd, Tokyo, Japan
| | - Yong Dam Jeong
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
- Department of Mathematics, Pusan National University, Busan, South Korea
| | - Daiki Tatematsu
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Marwa Akao
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Yoshitaka Sato
- Department of Virology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoya Iwanami
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Yasuhisa Fujita
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Masatoshi Wakui
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuyuki Aihara
- International Research Center for Neurointelligence, The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Tokyo, Japan
| | - Tatsuhiko Kodama
- Laboratory for Systems Biology and Medicine, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Kenji Shibuya
- Soma Medical Center of Vaccination for COVID-19, Fukushima, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Shingo Iwami
- interdisciplinary Biology Laboratory (iBLab), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
- Institute of Mathematics for Industry, Kyushu University, Fukuoka, Japan
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
- Interdisciplinary Theoretical and Mathematical Sciences Program (iTHEMS), RIKEN, Saitama, Japan
- NEXT-Ganken Program, Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan
- Science Groove Inc., Fukuoka, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of General Internal Medicine, Hirata Central Hospital, Fukushima, Japan
- Medical Governance Research Institute, Tokyo, Japan
- Minamisoma Municipal General Hospital, Fukushima, Japan
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Schlegel M, Bachmann S. Influence of the COVID-19 Pandemic on Medical Management and on Healthcare Delivery of Immune-Mediated Rheumatic and Musculoskeletal Diseases during the First Pandemic Period February to July 2020: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:596. [PMID: 38674242 PMCID: PMC11052197 DOI: 10.3390/medicina60040596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
(1) Background and Objectives: The COVID-19 pandemic influenced the management of patients with immune-mediated rheumatic and musculoskeletal diseases (imRMDs) in various ways. The goal of our systematic review was to determine the influence of the first period of the COVID-19 pandemic (February 2020 to July 2020) on the management of imRMDs regarding the availability of drugs, adherence to therapy and therapy changes and on healthcare delivery. (2) Materials and Methods: We conducted a systematic literature search of PubMed, Cochrane and Embase databases (carried out 20-26 October 2021), including studies with adult patients, on the influence of the COVID-19 pandemic on the management of imRMDs. There were no restrictions regarding to study design except for systematic reviews and case reports that were excluded as well as articles on the disease outcomes in case of SARS-CoV-2 infection. Two reviewers screened the studies for inclusion, and in case of disagreement, a consensus was reached after discussion. (3) Results: A total of 5969 potentially relevant studies were found, and after title, abstract and full-text screening, 34 studies were included with data from 182,746 patients and 2018 rheumatologists. The non-availability of drugs (the impossibility or increased difficulty to obtain a drug), e.g., hydroxychloroquine and tocilizumab, was frequent (in 16-69% of patients). Further, medication non-adherence was reported among patients with different imRMDs and between different drugs in 4-46% of patients. Changes to preexisting medication were reported in up to 33% of patients (e.g., reducing the dose of steroids or the cessation of biological disease-modifying anti-rheumatic drugs). Physical in-office consultations and laboratory testing decreased, and therefore, newly implemented remote consultations (particularly telemedicine) increased greatly, with an increase of up to 80%. (4) Conclusions: The COVID-19 pandemic influenced the management of imRMDs, especially at the beginning. The influences were wide-ranging, affecting the availability of pharmacies, adherence to medication or medication changes, avoidance of doctor visits and laboratory testing. Remote and telehealth consultations were newly implemented. These new forms of healthcare delivery should be spread and implemented worldwide to routine clinical practice to be ready for future pandemics. Every healthcare service provider treating patients with imRMDs should check with his IT provider how these new forms of visits can be used and how they are offered in daily clinical practice. Therefore, this is not only a digitalization topic but also an organization theme for hospitals or outpatient clinics.
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Affiliation(s)
- Marco Schlegel
- Department of Rheumatology, Rehabilitations Zentrum Valens, Kliniken Valens, 7317 Valens, Switzerland
| | - Stefan Bachmann
- Department of Rheumatology, Rehabilitations Zentrum Valens, Kliniken Valens, 7317 Valens, Switzerland
- Department of Geriatrics, Inselspital, Bern University Hospital, Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
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10
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Bournia VK, Fragoulis GE, Mitrou P, Mathioudakis K, Konstantonis G, Tektonidou MG, Tsolakidis A, Paraskevis D, Sfikakis PP. Outcomes of COVID-19 Omicron variant in patients with rheumatoid arthritis: a nationwide Greek cohort study. Rheumatology (Oxford) 2024; 63:1130-1138. [PMID: 37467059 PMCID: PMC10986801 DOI: 10.1093/rheumatology/kead354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVES Patients with RA were at increased risk for COVID-19-associated hospitalization and death during the first year of the pandemic in Greece. We aimed to examine their outcomes after the SARS-Cov-2 Omicron, a more contagious but with milder clinical impacts variant, prevailed. METHODS A retrospective, nationwide study was conducted between 1 January 2022 and 30 June 2022 in all RA patients under treatment and matched (1:5) on age, sex and region of domicile random general population comparators. Confirmed SARS-CoV-2 infections, hospitalizations and deaths, anti-rheumatic medications, prior COVID-19, vaccinations and anti-viral medications were recorded. RESULTS Among 34 182 RA patients, infections (n = 5569, 16.29%), hospitalizations (n = 489, 1.43%) and deaths (n = 106, 0.31%) were more frequent than among comparators. Incidence rates per 1000 person/years of infection [IRR (95% CI):1.19 (1.16, 1.23)], hospitalization [IRR (95% CI):2.0 (1.82, 2.24)], and death [IRR (95% CI):1.81 (1.44, 2.27)] were increased in RA despite better vaccination coverage (89% vs 84%) and more frequent use of anti-viral medications (2.37% vs 1.08). Logistic regression analysis after correcting for age, sex, vaccinations, prior COVID-19, and anti-viral medications in SARS-CoV-2 infected RA patients and comparators revealed increased risk of hospitalization (OR: 2.02, 95% CI: 1.79, 2.27) and death [OR: 1.73, (95% CI: 1.36, 2.20)] in RA. Among infected RA patients, rituximab treatment conferred increased risks for hospitalization [OR: 6.12, (95% CI: 2.89, 12.92)] and death [OR: 12.06 (95% CI: 3.90, 37.31)], while JAK inhibitors increased only hospitalization risk [OR: 2.18 (95% CI: 1.56, 3.06)]. CONCLUSION RA remains a risk factor for hospitalization and death in an era of a relatively low COVID-19 fatality rate, pointing to the need of perseverance in vaccination programs and wider use of anti-viral medications.
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Affiliation(s)
- Vasiliki-Kalliopi Bournia
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - George E Fragoulis
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - George Konstantonis
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Dimitrios Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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11
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Chen C, Huang S, Geng L, Lai P, Dou H, Zhang H, Chen H, Liang J, Sun L. COVID-19 vaccination and infection status: a cross-sectional survey of patients with rheumatic diseases in China. Rheumatol Int 2024; 44:703-713. [PMID: 37897662 DOI: 10.1007/s00296-023-05438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/16/2023] [Indexed: 10/30/2023]
Abstract
To evaluate the vaccination status and clinical practice of patients with rheumatic diseases (RD) during the COVID-19 pandemic in China and to explore the impact of vaccination on infection severity in patients with RD. A cross-sectional survey was conducted among RD patients in outpatient and inpatient settings of the Rheumatology and Immunology Department in our hospital. Participants' characteristics, vaccination status, COVID-19 infection status, and medication for acute COVID-19 were collected. A total of 749 valid surveys were included in the study. A total of 271 (36.2%) patients were not vaccinated, and 478 (63.8%) patients received at least one dose of COVID-19 vaccine. 83.3% of patients were vaccinated with inactivated vaccines. Several patients with RD experienced the disease flare (57, 11.9%) and some adverse reactions (31, 6.5%) after COVID-19 vaccination. The COVID-19 infection rate was 84.1% in our study, which was not reduced by vaccination. However, vaccinated patients with RD showed decreased frequencies of pneumonia and hospitalization, compared with those of unvaccinated patients. Independent factors associated with hospitalization were COVID-19 vaccination (OR = 0.422, 95% CI 0.227-0.783), advanced age (OR = 1.070, 95% CI 1.046-1.095), ILD (OR = 1.245, 95% CI 1.082-1.432), and glucocorticoid (OR = 4.977, 95% CI 2.326-10.647). Adverse reactions to vaccines and disease flare are not common in RD patients. Although COVID-19 vaccination could not reduce the risk of COVID-19 infection in RD patients, it may effectively decrease the frequencies of pneumonia and hospitalization after infection. It is recommended that patients with RD should receive COVID-19 vaccination if there are no contraindications because the benefits outweigh the risks.
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Affiliation(s)
- Chen Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Saisai Huang
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Linyu Geng
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Peng Lai
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Huan Dou
- Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, 210093, China
| | - Huayong Zhang
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Haifeng Chen
- Department of Rheumatology and Immunology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, 299 Qingyang Road, Wuxi, 214000, Jiangsu, China.
| | - Jun Liang
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Lingyun Sun
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
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12
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Fan Y, Huang S, Wu D, Chu M, Zhao J, Zhang J, Wang Y, Gui Y, Ye X, Wang G, Geng Y, Wang Y, Zhang Z. Immune features revealed by single-cell RNA and single-cell TCR/BCR sequencing in patients with rheumatoid arthritis receiving COVID-19 booster vaccination. J Med Virol 2024; 96:e29573. [PMID: 38566569 DOI: 10.1002/jmv.29573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, have profoundly affected human health. Booster COVID-19 vaccines have demonstrated significant efficacy in reducing infection and severe cases. However, the effects of booster COVID-19 vaccines on key immune cell subsets and their responses in rheumatoid arthritis (RA) are not well understood. By using single-cell RNA sequencing (scRNA-seq) combined with scTCR/BCR-seq analysis, a total of 8 major and 27 minor cell clusters were identified from paired peripheral blood mononuclear cells (PBMCs) which were collected 1 week before and 4 weeks after booster vaccination in stable RA patients. Booster vaccination only had limited impact on the composition and proportions of PBMCs cell clusters. CD8+ cytotoxic T cells (CD8+T_CTL) showed a trend toward an increase after vaccination, while naive B cells and conventional dendritic cells (cDCs) showed a trend toward a decrease. Transcriptomic changes were observed after booster vaccination, primarily involving T/B cell receptor signaling pathways, phagosome, antigen processing and presenting, and viral myocarditis pathways. Interferon (IFN) and pro-inflammatory response gene sets were slightly upregulated across most major cell subpopulations in COVID-19 booster-vaccinated RA individuals. Plasma neutralizing antibody titers significantly increased after booster COVID-19 vaccination (p = 0.037). Single-cell TCR/BCR analysis revealed increased B cell clone expansion and repertoire diversity postvaccination, with no consistent alterations in T cells. Several clonotypes of BCRs and TCRs were identified to be significantly over-represented after vaccination, such as IGHV3-15 and TRBV28. Our study provided a comprehensive single-cell atlas of the peripheral immune response and TCR/BCR immune repertoire profiles to inactivated SARS-CoV-2 booster vaccination in RA patients, which helps us to understand vaccine-induced immune responses better.
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Affiliation(s)
- Yong Fan
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Siyuan Huang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Duo Wu
- Kindstar Global Precision Medicine Institute, Wuhan, China
| | - Ming Chu
- NHC Key Laboratory of Medical Immunology (Peking University), Department of Immunology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Juan Zhao
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Jiaying Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yu Wang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yanni Gui
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Xiaofei Ye
- Kindstar Global Precision Medicine Institute, Wuhan, China
| | - Guiqiang Wang
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Yan Geng
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
| | - Yuedan Wang
- NHC Key Laboratory of Medical Immunology (Peking University), Department of Immunology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Zhuoli Zhang
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China
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13
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Kim AHJ. Additional Reassuring Data for SARS-CoV-2 Vaccination in Immune-Mediated Inflammatory Diseases, but With a Catch. J Rheumatol 2024; 51:332-335. [PMID: 38302175 PMCID: PMC10984787 DOI: 10.3899/jrheum.2024-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Alfred H J Kim
- A.H.J. Kim, MD, PhD, Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
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14
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Kashiwado Y, Kimoto Y, Oku K, Yamamoto M, Ohshima S, Ito S, Horiuchi T, Takeuchi T. Prognostic improvement and treatment of COVID-19 in patients with rheumatic diseases until December 2022: Analysis of the JCR COVID-19 registry in Japan. Mod Rheumatol 2024; 34:576-583. [PMID: 37338284 DOI: 10.1093/mr/road057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES The aim is to evaluate the treatment and prognosis of coronavirus disease 2019 (COVID-19) according to the time of onset and dominant strain in patients with rheumatic diseases. METHODS This study analysed a nationwide COVID-19 registry of Japanese patients with rheumatic diseases compiled between June 2020 and December 2022. The primary endpoints of the study were hypoxaemia incidence and mortality. Multivariate logistic regression analysis was performed to assess differences according to the period of onset. RESULTS A total of 760 patients were compared across four periods. Hypoxaemia rates were 34.9, 27.2, 13.8, and 6.1% and mortality rates were 5.6, 3.5, 1.8, and 0% until June 2021, between July and December 2021, January and June 2022, and July and December 2022, respectively. History of vaccination (odds ratio, 0.39; 95% confidence interval, 0.18-0.84) and onset during the July to December 2022 Omicron BA.5-dominant period (odds ratio, 0.17; 95% confidence interval, 0.07-0.41) were negatively associated with hypoxaemia in the multivariate model, adjusting for age, sex, obesity, glucocorticoid dose, and comorbidities. Over the Omicron-dominant period, antiviral treatment was administered in 30.5% of patients with a low probability of hypoxaemia. CONCLUSIONS COVID-19 prognosis improved over time in patients with rheumatic diseases, especially in the Omicron BA.5-dominant period. In the future, treatment of mild cases should be optimised.
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Affiliation(s)
- Yusuke Kashiwado
- Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan
| | - Yasutaka Kimoto
- Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan
| | - Kenji Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mari Yamamoto
- Department of Rheumatology and Nephrology, Chubu Rosai Hospital, Aichi, Japan
| | - Shiro Ohshima
- Department of Clinical Research, Rheumatology and Allergology, Osaka Minami Medical Center, Osaka, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan
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15
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Wu W, Wang R, Xie C, Chen Y, Teng X, Sun S, Xu W, Fu Y, Ma Y, Xu A, Lyu X, Ye Y, Li J, Zhang C, Shen N, Wang X, Ye S, Fu Q. Anti-synthetase syndrome is associated with a higher risk of hospitalization among patients with idiopathic inflammatory myopathy and COVID-19. Front Immunol 2024; 15:1295472. [PMID: 38500883 PMCID: PMC10944926 DOI: 10.3389/fimmu.2024.1295472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Background Data with fine granularity about COVID-19-related outcomes and risk factors were still limited in the idiopathic inflammatory myopathies (IIMs) population. This study aimed to investigate clinical factors associated with hospitalized and severe COVID-19 in patients with IIMs, particularly those gauged by myositis-specific antibodies. Methods This retrospective cohort study was conducted in the Renji IIM cohort in Shanghai, China, under an upsurge of SARS-CoV-2 omicron variant infections from December 2022 to January 2023. Clinical data were collected and analyzed by multivariable logistic regression to determine risk factors. High-dimensional flow cytometry analysis was performed to outline the immunological features. Results Among 463 infected patients in the eligible cohort (n=613), 65 (14.0%) were hospitalized, 19 (4.1%) suffered severe COVID-19, and 10 (2.2%) died. Older age (OR=1.59/decade, 95% CI 1.18 to 2.16, p=0.003), requiring family oxygen supplement (2.62, 1.11 to 6.19, 0.028), patients with anti-synthetase syndrome (ASyS) (2.88, 1.12 to 7.34, 0.027, vs. other dermatomyositis), higher IIM disease activity, and prednisone intake >10mg/day (5.59, 2.70 to 11.57, <0.001) were associated with a higher risk of hospitalization. Conversely, 3-dose inactivated vaccination reduced the risk of hospitalization (0.10, 0.02 to 0.40, 0.001, vs. incomplete vaccination). Janus kinase inhibitor (JAKi) pre-exposure significantly reduced the risk of severe COVID-19 in hospitalized patients (0.16, 0.04 to 0.74, 0.019, vs. csDMARDs). ASyS patients with severe COVID-19 had significantly reduced peripheral CD4+ T cells, lower CD4/CD8 ratio, and fewer naive B cells but more class-switched memory B cells compared with controls. Conclusion ASyS and family oxygen supplement were first identified as risk factors for COVID-19-related hospitalization in patients with IIMs. JAKi pre-exposure might protect IIM patients against severe COVID-19 complications.
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Affiliation(s)
- Wanlong Wu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runci Wang
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuiying Xie
- Department of Emergency Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Department of Emergency Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyu Teng
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuhui Sun
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenwen Xu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yakai Fu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiyangzi Ma
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Antao Xu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Lyu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Ye
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Li
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Zhang
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Shen
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Wang
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Fu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Kawano Y, Wang X, Patel NJ, Qian G, Kowalski E, Bade KJ, Vanni KMM, Jonsson AH, Williams ZK, Cook CE, Srivatsan S, Wallace ZS, Sparks JA. Breakthrough COVID-19 After Tixagevimab/Cilgavimab Among Patients With Systemic Autoimmune Rheumatic Diseases. J Rheumatol 2024; 51:305-312. [PMID: 37839812 PMCID: PMC10925916 DOI: 10.3899/jrheum.2023-0742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To determine the incidence and baseline factors associated with breakthrough coronavirus disease 2019 (COVID-19) after preexposure prophylaxis (PrEP) with tixagevimab/cilgavimab among patients with systemic autoimmune rheumatic diseases (SARDs). METHODS We performed a retrospective cohort study among patients with SARDs who received tixagevimab/cilgavimab between January 2, 2022, and November 16, 2022. The primary outcome was breakthrough COVID-19 after tixagevimab/cilgavimab. We performed multivariable Cox regression models adjusted for baseline factors to identify risk factors for breakthrough COVID-19. RESULTS We identified 444 patients with SARDs who received tixagevimab/cilgavimab (mean age 62.0 years, 78.2% female). There were 83 (18.7%) breakthrough COVID-19 cases (incidence rate 31.5/1000 person-months, 95% CI 24.70-38.24), 7 (1.6%) hospitalizations, and 1 (0.2%) death. Older age was inversely associated with breakthrough COVID-19 (adjusted hazard ratio [aHR] 0.86/10 years, 95% CI 0.75-0.99). Higher baseline spike antibody levels were associated with lower risk of breakthrough COVID-19 (aHR 0.42, 95% CI 0.18-0.99 for spike antibody levels > 200 vs < 0.4 units). CD20 inhibitor users had a similar risk of breakthrough COVID-19 (aHR 1.05, 95% CI 0.44-2.49) compared to conventional synthetic disease-modifying antirheumatic drug (DMARD) users. CONCLUSION We found that patients with SARDs had frequent breakthrough COVID-19, but the proportion experiencing severe COVID-19 was low. DMARD type, including CD20 inhibitors, did not significantly affect risk of breakthrough COVID-19. Evidence of prior humoral immunity was protective against breakthrough infection, highlighting the continued need for a multimodal approach to prevent severe COVID-19 as novel PrEP therapies are being developed.
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Affiliation(s)
- Yumeko Kawano
- Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School
| | - Xiaosong Wang
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Naomi J Patel
- N.J. Patel, MD, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School
| | - Grace Qian
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Emily Kowalski
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Katarina J Bade
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Kathleen M M Vanni
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - A Helena Jonsson
- Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School
| | - Zachary K Williams
- Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire E Cook
- Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shruthi Srivatsan
- Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary S Wallace
- N.J. Patel, MD, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School
| | - Jeffrey A Sparks
- Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School;
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17
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Isaacs JD. CAR T Cells - A New Horizon for Autoimmunity? N Engl J Med 2024; 390:758-759. [PMID: 38381679 DOI: 10.1056/nejme2400203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- John D Isaacs
- From the Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, and the Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital - both in Newcastle upon Tyne, United Kingdom
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18
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Li R, Zhao JK, Li Q, Zhao L, Su YZ, Zhang JY, Zhang LY. Analysis of related factors for RA flares after SARS-CoV-2 infection: a retrospective study from patient survey. Sci Rep 2024; 14:4243. [PMID: 38378889 PMCID: PMC10879520 DOI: 10.1038/s41598-024-52748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
SARS-CoV-2 and its variants are widely prevalent worldwide. With frequent secondary and breakthrough infections, immune dysfunction in RA patients, and long-term use of immune preparations, SARS-CoV-2 infection poses a significant challenge to patients and rheumatologists. Whether SARS-CoV-2 infection causes RA flares and what factors aggravate RA flares are poorly studied. A questionnaire survey was conducted on RA patients infected with SARS-CoV-2 after December 7, 2022, in China through a multicenter and inter-network platform regarding general personal condition, primary disease, comorbidity, SARS-CoV-2 vaccination, viral infection, and impact on the primary disease. A total of 306 RA patients were included in this study, and the patient data were analyzed, in which the general condition of RA patients, medication use before SARS-CoV-2 infection and post-infection typing and manifestations, and medication adjustment did not affect the Flare of RA patients after SARS-CoV-2 infection. The control of disease before SARS-CoV-2 infection (OR = 2.10), RA involving pulmonary lesions (OR = 2.28), and the recovery time of COVID-19 (OR = 2.50) were risk factors for RA flare. RA involving pulmonary lesions, control status of disease before infection, and recovery time of COVID-19 disease are risk factors for RA flare after SARS-CoV-2 infection.
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Affiliation(s)
- Rong Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Jun-Kang Zhao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Qian Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Li Zhao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Ya-Zhen Su
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Jun-Yan Zhang
- Department of Clinical Epidemiology and Evidence-Based Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Li-Yun Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
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19
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Yazdany J, Ware A, Wallace ZS, Bhana S, Grainger R, Hachulla E, Richez C, Cacoub P, Hausmann JS, Liew JW, Sirotich E, Jacobsohn L, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Ribeiro SLE, Al-Emadi S, Hasseli R, Müller-Ladner U, Specker C, Schulze-Koops H, Bernardes M, Fraga VM, Rodrigues AM, Sparks JA, Ljung L, Di Giuseppe D, Tidblad L, Wise L, Duarte-García A, Ugarte-Gil MF, Colunga-Pedraza IJ, Martínez-Martínez MU, Alpizar-Rodriguez D, Xavier RM, Isnardi CA, Pera M, Pons-Estel G, Izadi Z, Gianfrancesco MA, Carrara G, Scirè CA, Zanetti A, Machado PM. Impact of Risk Factors on COVID-19 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the COVID-19 Global Rheumatology Alliance Registry. Arthritis Care Res (Hoboken) 2024; 76:274-287. [PMID: 37643903 DOI: 10.1002/acr.25220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern. METHODS Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates. The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types. RESULTS Among 19,256 unvaccinated people with RDs and COVID-19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B-cell-depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B-cell-depleting therapy was associated with worse outcomes. CONCLUSION Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study.
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Affiliation(s)
| | - Anna Ware
- National Center for Collaborative Healthcare Innovation, Palo Alto Department of Veterans Affairs Healthcare System, Palo Alto, California
| | | | | | - Rebecca Grainger
- University of Otago Wellington and Te Whatu Ora, Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire (CHU) de Lille, pour la Filière des maladies Auto-Immunes et Autoinflammatoires Rares, Lille, France
| | - Christophe Richez
- Service de Rhumatologie, Centre de référence des maladies autoimmunes systémiques rares de l'Est et du Sud-Ouest de France, CHU de Bordeaux, pour la Société Française de Rhumatologie, Bordeaux, France
| | - Patrice Cacoub
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Société Nationale Française de Médecine Interne, Paris, France
| | - Jonathan S Hausmann
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jean W Liew
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | | | - Anja Strangfeld
- German Rheumatism Research Center and Charité University Hospital, Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal, and European Alliance of Associations for Rheumatology, Kilchberg, Switzerland
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Pitié-Salpêtrière hospital, Paris, France
| | | | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Rebecca Hasseli
- University Hospital Munster, Munster, Germany, and Justus Liebig University Giessen, Kerckhoff, Germany
| | | | | | | | - Miguel Bernardes
- University of Porto and Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Ana Maria Rodrigues
- Sociedade Portuguesa de Reumatologia and Comprehensive Health Research Centre, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lotta Ljung
- Karolinska Institutet and Academic Specialist Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | | | - Leanna Wise
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Manuel F Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémica, Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, Lima, Peru
| | | | | | | | - Ricardo Machado Xavier
- Universidade Federal do Rio Grande do Sul, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Mariana Pera
- Hospital Angel C. Padilla, San Miguel de Tucuman, Tucuman, Argentina
| | - Guillermo Pons-Estel
- Universidad Nacional de Rosario, Rosario, Argentina, and College of Physicians of the Province of Santa Fe 2nd, Santa Fe, Argentina
| | | | | | | | - Carlo Alberto Scirè
- Italian Society for Rheumatology and School of Medicine, University of Milano-Bicocca, Milan, Italy
| | | | - Pedro M Machado
- University College London, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, and Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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20
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Cheema HA, Akhlaq A, Mustafa B, Shahid A, Ayyan M, Edigin E. Outcomes in systemic sclerosis patients hospitalized with COVID-19: Insight from the National Inpatient Sample. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:16-22. [PMID: 38333522 PMCID: PMC10848934 DOI: 10.1177/23971983231210340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/30/2023] [Indexed: 02/10/2024]
Abstract
Objective COVID-19, a respiratory infection caused by the novel coronavirus SARS-CoV-2, can cause varying degrees of illness ranging from mild respiratory illness to severe respiratory failure. Systemic sclerosis is a chronic autoimmune disease, with an increased prevalence of infections as compared to the general population. In this study, we compare the clinical outcomes and resource utilization for COVID-19 hospitalizations in patients with and without systemic sclerosis. Methods We used the National Inpatient Sample database, 2020, to study the characteristics, morbidity, mortality, cost, and resource utilization among primary COVID-19 hospitalizations with and without systemic sclerosis. Results There were 1,050,040 patients aged ⩾ 18 years with a diagnosis of COVID-19. Of these, 775 (0.07%) patients had a secondary diagnosis of systemic sclerosis. Although there was no statistically significant difference regarding individual outcomes; in-hospital mortality, vasopressor use, cardiac arrest, acute kidney injury, and disposition to facility were numerically higher in hospitalizations with systemic sclerosis. The composite endpoint of major adverse events was higher in the systemic sclerosis cohort (adjusted odds ratio 1.52, 95% confidence interval: 1.06-2.17, p = 0.022). Conclusion COVID-19 patients with systemic sclerosis had worse outcomes (i.e. higher composite endpoint of major adverse events) than those without systemic sclerosis. Further studies are needed to establish a better understanding of the relationship between COVID-19 and systemic sclerosis.
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Affiliation(s)
| | - Anum Akhlaq
- Department of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Biah Mustafa
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Abia Shahid
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Ayyan
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ehizogie Edigin
- Department of Rheumatology, Loma Linda University Health, Loma Linda, CA, USA
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21
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Röltgen K, Boyd SD. Antibody and B Cell Responses to SARS-CoV-2 Infection and Vaccination: The End of the Beginning. ANNUAL REVIEW OF PATHOLOGY 2024; 19:69-97. [PMID: 37738512 DOI: 10.1146/annurev-pathmechdis-031521-042754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
As the COVID-19 pandemic has evolved during the past years, interactions between human immune systems, rapidly mutating and selected SARS-CoV-2 viral variants, and effective vaccines have complicated the landscape of individual immunological histories. Here, we review some key findings for antibody and B cell-mediated immunity, including responses to the highly mutated omicron variants; immunological imprinting and other impacts of successive viral antigenic variant exposures on antibody and B cell memory; responses in secondary lymphoid and mucosal tissues and non-neutralizing antibody-mediated immunity; responses in populations vulnerable to severe disease such as those with cancer, immunodeficiencies, and other comorbidities, as well as populations showing apparent resistance to severe disease such as many African populations; and evidence of antibody involvement in postacute sequelae of infection or long COVID. Despite the initial phase of the pandemic ending, human populations will continue to face challenges presented by this unpredictable virus.
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Affiliation(s)
- Katharina Röltgen
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA;
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA
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22
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Ahmed S, Gupta L, Kuwana M, Pauling JD, Day J, Ravichandran N, Joshi M, Parodis I, Sen P, Jagtap K, Nikiphorou E, Saha S, Agarwal V, Chatterjee T, Lilleker JB, Kardes S, Milchert M, Gheita T, Salim B, Velikova T, Gracia-Ramos AE, Tan AL, Nune A, Cavagna L, Saavedra MA, Shinjo SK, Ziade N, Knitza J, Distler O, Wibowo SAK, Chinoy H, Aggarwal R, Agarwal V, Makol A. Correlates of breakthrough COVID-19 in vaccinated patients with systemic sclerosis: survival analysis from a multicentre international patient-reported survey. Rheumatol Int 2024; 44:89-97. [PMID: 37668836 DOI: 10.1007/s00296-023-05433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023]
Abstract
This study aimed to assess the incidence, predictors, and outcomes of breakthrough infection (BI) following coronavirus disease (COVID-19) vaccination in patients with systemic sclerosis (SSc), a risk group associated with an immune-suppressed state and high cardiopulmonary disease burden. Cross-sectional data from fully vaccinated respondents with SSc, non-SSc autoimmune rheumatic diseases (AIRDs), and healthy controls (HCs) were extracted from the COVAD database, an international self-reported online survey. BI was defined according to the Centre for Disease Control definition. Infection-free survival was compared between the groups using Kaplan-Meier curves with log-rank tests. Cox proportional regression was used to assess the association between BI and age, sex, ethnicity, and immunosuppressive drugs at the time of vaccination. The severity of BI in terms of hospitalization and requirement for oxygen supplementation was compared between groups. Of 10,900 respondents, 6836 fulfilled the following inclusion criteria: 427 SSc, 2934 other AIRDs, and 3475 HCs. BI were reported in 6.3% of SSc, 6.9% of non-SSc AIRD, and 16.1% of HCs during a median follow-up of 100 (IQR: 60-137) days. SSc had a lower risk for BI than HC [hazard ratio (HR): 0.56 (95% CI 0.46-0.74)]. BIs were associated with age [HR: 0.98 (0.97-0.98)] but not ethnicity or immunosuppressive drugs at the time of vaccination. Patients with SSc were more likely to have asymptomatic COVID-19, but symptomatic patients reported more breathlessness. Hospitalization [SSc: 4 (14.8%), HCs: 37 (6.6%), non-SSc AIRDs: 32(15.8%)] and the need for oxygenation [SSc: 1 (25%); HC: 17 (45.9%); non-SSc AIRD: 13 (40.6%)] were similar between the groups. The incidence of BI in SSc was lower than that in HCs but comparable to that in non-SSc AIRDs. The severity of BI did not differ between the groups. Advancing age, but not ethnicity or immunosuppressive medication use, was associated with BIs.
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Affiliation(s)
- Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, Bhubaneshwar, India
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - John D Pauling
- Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Naveen Ravichandran
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Parikshit Sen
- Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, Delhi, 110002, India
| | - Kshitij Jagtap
- Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Sreoshy Saha
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - Vishwesh Agarwal
- Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
| | - Tulika Chatterjee
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Sinan Kardes
- Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey
| | - Marcin Milchert
- Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, ul Unii Lubelskiej 1, 71-252, Szczecin, Poland
| | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Babur Salim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407, Sofia, Bulgaria
| | - Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, CP 02990, Mexico City, Mexico
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Arvind Nune
- Southport and Ormskirk Hospital NHS Trust, Southport, PR8 6PN, UK
| | - Lorenzo Cavagna
- Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia, Pavia, Lombardy, Italy
| | - Miguel A Saavedra
- Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
- Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Johannes Knitza
- Medizinische Klinik 3-Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Suryo Anggoro Kusumo Wibowo
- Rheumatology Division, Department of Internal Medicine, Fakultas Kedokteran Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hector Chinoy
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
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23
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Feldman DE, Mazer B. Long COVID in Persons With Self-Reported Arthritis: Symptoms, Associated Factors, and Functional Limitations. Arthritis Care Res (Hoboken) 2024; 76:57-62. [PMID: 37485778 DOI: 10.1002/acr.25200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE The aim is to describe both long COVID symptoms and associated factors in a cohort of individuals with a self-reported history of arthritis as well as change in function in persons with arthritis and long COVID compared to pre-COVID status. METHODS Among 2,764 persons with a confirmed COVID-19 diagnosis who responded to an online survey at least 12 weeks post-infection, 171 reported a history of arthritis and formed our study sample. We calculated the frequency of long COVID defined as troubled by persistent symptoms and evaluated associated factors using bivariate analysis and multivariable logistic regression. Among those with long COVID, we describe limitations in activity and function in comparison to pre-COVID status. RESULTS In our sample, 53.5% (n = 91) reported being troubled by ongoing symptoms at the time of completing the questionnaire (long COVID), with the most frequent symptoms as the following: fatigue, myalgia, weakness, breathlessness, low mood, anxiety, and sleep disturbance. Factors associated with long COVID were female sex, having been hospitalized for COVID, and having at least 1 other chronic disease. Persons with long COVID had substantial declines in function, notably in global health status, usual activities, mobility, personal care, and employment status. Also, 37% of those with long COVID reported moderate to severe increase in pain. CONCLUSION Persons with arthritis who have long COVID have substantial limitations in function compared to their pre-COVID status. There is a need to implement effective interventions to improve functional status in persons with arthritis and long COVID.
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Affiliation(s)
- Debbie Ehrmann Feldman
- Université de Montréal, Centre de recherche interdisciplinaire en réadaptation, and Centre de recherche en Santé Publique, Montreal, Quebec, Canada
| | - Barbara Mazer
- McGill University, and Centre for interdisciplinary research in rehabilitation, Montreal, Quebec, Canada
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24
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Leese J, Therrien S, Ramachandran S, Backman CL, Ma JK, Koehn CL, Hoens AM, English K, Davidson E, McQuitty S, Gavin J, Adams J, Li LC. Decision-Making Around COVID-19 Public Health Measures and Implications for Self-Care Activities: Experiences of Persons With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2024; 76:140-152. [PMID: 37870115 DOI: 10.1002/acr.25262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE We aimed to advance understanding of how persons with rheumatoid arthritis (RA) experience decision-making about adopting public health measures during the COVID-19 pandemic. METHODS Persons living with RA partnered throughout this nested qualitative study. One-to-one semistructured telephone interviews were conducted with participants with RA between December 2020 and December 2021. They were strategically sampled from a randomized controlled trial that was underway to test a physical activity counseling intervention. Analysis was guided by reflexive thematic analysis. RESULTS Thirty-nine participants (aged 26-86 years; 36 women) in British Columbia, Canada were interviewed. We developed three themes. Participants described how their decision-making about public health measures related to 1) "upholding moral values of togetherness" because decisions were intertwined with moral values of neighborliness and reciprocity. Some adapted their self-care routines to uphold these moral values; 2) "relational autonomy-supports and challenges," because they sometimes felt supported and undermined in different relational settings (eg, by family, local community, or provincial government); and 3) "differing trust in information sources," in which decisions were shaped by the degree of faith they had in various information sources, including their rheumatologists. CONCLUSION Across themes, experiences of decision-making about public health measures during the pandemic were embedded with moral concepts of solidarity, autonomy, and trust, with implications for how persons with RA chose and sustained their self-care activities. Insights gained help sensitize researchers and clinicians to moral issues experienced by persons with RA, which may inform support for self-care activities during and after the pandemic.
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Affiliation(s)
- Jenny Leese
- Arthritis Research Canada, Vancouver, British Columbia, and University of Ottawa, Ottawa, Ontario, Canada
| | | | - Smruthi Ramachandran
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine L Backman
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmin K Ma
- Arthritis Research Canada and University of British Columbia and International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
| | - Cheryl L Koehn
- Arthritis Consumer Experts, Vancouver, British Columbia, Canada
| | - Alison M Hoens
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly English
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Eileen Davidson
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Shanon McQuitty
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Jo Adams
- University of Southampton, Southampton, UK
| | - Linda C Li
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
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25
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Marinkov A, Dimova R, Karalilova R, Keskinova D, Bahariev D, Batalov K, Popova V, Batalov Z, Batalov A. The COVID-19 pandemic's impact on rheumatic disease patients' satisfaction with access to medical services. Rheumatol Int 2024; 44:157-164. [PMID: 37776498 DOI: 10.1007/s00296-023-05413-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 10/02/2023]
Abstract
The COVID-19 hurt various lifestyle aspects, especially the treatment and follow-up of patients with chronic diseases such as autoimmune inflammatory rheumatic diseases (RD). The new circumstances changed the frequency of medical examinations and the way patients with rheumatic diseases are followed up. The objective is to study the impact of COVID-19 on RD patients' satisfaction with access to medical services. A national multicenter observational cross-sectional anonymous online survey was conducted on patients with RD using a specially developed web-based platform and structured questionnaire https://rheumatologycovid19.bg/ . The study was carried out with the support of intra-university project №6/2022 MU-Plovdiv. 1288 patients participated, with an average age of 47.03 (SD ± 12.80 years), of whom 992 (81.6%) were women. The questionnaire contained 41 questions grouped into 5 panels. Descriptive statistics were used-mean, alternative analysis, logistic regression and Decision Tree using the CRT (classification and regression trees) method. The study found that RD patients' satisfaction with access to medical services was influenced by communication type and the frequency of visits to the rheumatologist, difficulties in prescribing and finding medicines and the presence of comorbidities. The likelihood of patients' satisfaction with their rheumatologist was 5.5 and 3 times higher for in-person and other means of communication, respectively, compared to those without any communication. The relative share of patients who communicated by phone was larger (59%) compared to pre-pandemic (41%), where direct contact with the physician prevailed (80%). The results of the study confirmed the need to optimize remote access to medical care for patients with RD during the pandemic.
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Affiliation(s)
- Aleksandar Marinkov
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str, Plovdiv, 4002, Bulgaria
| | - Rositsa Dimova
- Department of Health Management and Health Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, 4002, Bulgaria.
| | - Rositsa Karalilova
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str, Plovdiv, 4002, Bulgaria
| | - Donka Keskinova
- Department of Applied and Institutional Sociology, Faculty of Philosophy and History, University of Plovdiv Paisiy Hilendarski, Plovdiv, Bulgaria
| | - Dimitar Bahariev
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str, Plovdiv, 4002, Bulgaria
- Medical University of Plovdiv, Plovdiv, 4002, Bulgaria
| | - Konstantin Batalov
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str, Plovdiv, 4002, Bulgaria
| | - Velichka Popova
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str, Plovdiv, 4002, Bulgaria
| | - Zguro Batalov
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str, Plovdiv, 4002, Bulgaria
| | - Anastas Batalov
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str, Plovdiv, 4002, Bulgaria
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Kamegai K, Iwamoto N, Ishikane M, Yamamoto K, Horii K, Kubota S, Hangaishi A, Shimazu H, Togano T, Yamashita H, Yamada Y, Ohmagari N. A novel protocol for de-isolating moderately and severely immunocompromised COVID-19 patients. Glob Health Med 2023; 5:366-371. [PMID: 38162429 PMCID: PMC10730921 DOI: 10.35772/ghm.2023.01053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/19/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Immunocompromised coronavirus disease 2019 patients are at a higher risk of prolonged viral shedding than immunocompetent patients. However, as of August 2023, there is no clear international standard for de-isolating vulnerable patients. A comprehensive assessment is advisable based on various information, such as the increase in immune escape of specific mutant strains as well as the patient's innate immunity and vaccination status; therefore, consultation with an infectious disease specialist is recommended. The patient population defined as moderately or severely immunocompromised by the Centers for Disease Control and Prevention and the European Centre for Disease Prevention and Control is significantly broad. A boundary between the two remains to be delineated, and the existing protocols allow the release of patients based on their symptoms alone. This may lead to an unnecessary extension or premature termination of isolation. In this study, we searched for studies, particularly those that used real-world data, discussed the results with experts in our hospital, and proposed new isolation criteria based on both testing and clinical symptoms. We classified patients into three groups namely severely, moderately, and mildly immunocompromised, defined by their background and the administration of immunosuppressive drugs. A separate flowchart for ending isolation is indicated for each group. This standard may be a useful support material, especially for non-specialists. Nevertheless, our criteria must be revised and added continuously; accumulating real-world data to support revision of and addition to the list is becoming increasingly important.
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Affiliation(s)
- Kohei Kamegai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Iwamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kumi Horii
- Infection Control Office, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shiho Kubota
- Infection Control Office, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akira Hangaishi
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Shimazu
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomiteru Togano
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuhide Yamada
- Comprehensive Cancer Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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27
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Sim TM, Lahiri M, Ma M, Cheung PPM, Mak A, Fong W, Angkodjojo S, Xu C, Kong KO, Arkachaisri T, Phang KF, Tan TC, Yap QV, Chan YH, Sriranganathan M, Chuah TY, Roslan NE, Poh YJ, Law A, Santosa A, Tay SH. Latent Class Analysis Identifies Distinct Phenotypes of Systemic Lupus Erythematosus Predictive of Flares after mRNA COVID-19 Vaccination: Results from the Coronavirus National Vaccine Registry for ImmuNe Diseases SINGapore (CONVIN-SING). Vaccines (Basel) 2023; 12:29. [PMID: 38250842 PMCID: PMC10819486 DOI: 10.3390/vaccines12010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
We recently reported that messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccination was associated with flares in 9% of patients with systemic lupus erythematosus (SLE). Herein, we focused our analysis on patients from a multi-ethnic Southeast Asian lupus cohort with the intention of identifying distinct phenotypes associated with increased flares after mRNA COVID-19 vaccination. METHODS Six hundred and thirty-three SLE patients from eight public healthcare institutions were divided into test and validation cohorts based on healthcare clusters. Latent class analysis was performed based on age, ethnicity, gender, vaccine type, past COVID-19 infection, interruption of immunomodulatory/immunosuppressive treatment for vaccination, disease activity and background immunomodulatory/immunosuppressive treatment as input variables. Data from both cohorts were then combined for mixed effect Cox regression to determine which phenotypic cluster had a higher risk for time to first SLE flare, adjusted for the number of vaccine doses. RESULTS Two clusters were identified in the test (C1 vs. C2), validation (C1' vs. C2') and combined (C1″ vs. C2″) cohorts, with corresponding clusters sharing similar characteristics. Of 633 SLE patients, 88.6% were female and there was multi-ethnic representation with 74.9% Chinese, 14.2% Malay and 4.6% Indian. The second cluster (C2, C2' and C2″) was smaller compared to the first. SLE patients in the second cluster (C2 and C2') were more likely to be male, non-Chinese and younger, with higher baseline disease activity. The second cluster (C2″) had more incident flares (hazard ratio = 1.4, 95% confidence interval 1.1-1.9, p = 0.014) after vaccination. A higher proportion of patients in C2″ had immunomodulatory/immunosuppressive treatment interruption for vaccination as compared to patients in C1″ (6.6% vs. 0.2%) (p < 0.001). CONCLUSION We identified two distinct phenotypic clusters of SLE with different patterns of flares following mRNA COVID-19 vaccination. Caution has to be exercised in monitoring for post-vaccination flares in patients with risk factors for flares such as non-Chinese ethnicity, young age, male gender and suboptimal disease control at the time of vaccination.
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Affiliation(s)
- Tao Ming Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (T.M.S.)
| | - Manjari Lahiri
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Margaret Ma
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Peter Pak-Moon Cheung
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Warren Fong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Stanley Angkodjojo
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Chuanhui Xu
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.X.)
| | - Kok Ooi Kong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.X.)
| | - Thaschawee Arkachaisri
- Duke-NUS Medical School, Singapore 169857, Singapore;
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
| | - Kee Fong Phang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
- Chronic Programme, Alexandra Hospital, Singapore 159964, Singapore
| | - Teck Choon Tan
- Division of Rheumatology, Department of General Medicine, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (Q.V.Y.); (Y.H.C.)
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (Q.V.Y.); (Y.H.C.)
| | - Melonie Sriranganathan
- Division of Rheumatology, Department of Medicine, Changi General Hospital, Singapore 529889, Singapore
| | - Tyng Yu Chuah
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Nur Emillia Roslan
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Yih Jia Poh
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
| | - Annie Law
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
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Benoit JM, Breznik JA, Ang JC, Bhakta H, Huynh A, Cowbrough B, Baker B, Heessels L, Lodhi S, Yan E, Ewusie J, Nazy I, Bramson J, Miller MS, Bernatsky S, Larché MJ, Bowdish DME. Immunomodulatory drugs have divergent effects on humoral and cellular immune responses to SARS-CoV-2 vaccination in people living with rheumatoid arthritis. Sci Rep 2023; 13:22846. [PMID: 38129594 PMCID: PMC10739702 DOI: 10.1038/s41598-023-50263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
Understanding the efficacy of SARS-CoV-2 vaccination in people on immunosuppressive drugs, including those with rheumatoid arthritis (RA), is critical for their protection. Vaccine induced protection requires antibodies, CD4+ T cells, and CD8+ T cells, but it is unclear if these are equally affected by immunomodulatory drugs. Here, we determined how humoral and cellular SARS-CoV-2 vaccination responses differed between people with RA and controls, and which drug classes impacted these responses. Blood was collected from participants with RA on immunomodulatory drugs and controls after their second, third, and fourth SARS-CoV-2 vaccinations. Receptor binding domain (RBD)-specific antibodies were quantified by ELISA. Spike-specific memory T cells were quantitated using flow cytometry. Linear mixed models assessed the impact of age, sex, and immunomodulatory drug classes on SARS-CoV-2 vaccination responses. Compared to non-RA controls (n = 35), participants with RA on immunomodulatory drugs (n = 62) had lower anti-RBD IgG and spike-specific CD4+ T cell levels, but no deficits in spike-specific CD8+ T cells, following SARS-CoV-2 vaccination. Use of costimulation inhibitors was associated with lower humoral responses. JAK inhibitors were associated with fewer spike-specific CD4+ T cells. Participants with RA on immunomodulatory drugs mounted weaker responses to SARS-CoV-2 vaccination, with different drug classes impacting the cellular and humoral compartments.
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Affiliation(s)
- Jenna M Benoit
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- McMaster Immunology Research Centre, Hamilton, ON, Canada
- Firestone Institute of Respiratory Health, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Jessica A Breznik
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- McMaster Immunology Research Centre, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Jann C Ang
- Department of Biochemistry, McMaster University, Hamilton, ON, Canada
| | - Hina Bhakta
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Angela Huynh
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Braeden Cowbrough
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- McMaster Immunology Research Centre, Hamilton, ON, Canada
| | - Barbara Baker
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lauren Heessels
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sumiya Lodhi
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth Yan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Ishac Nazy
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonathan Bramson
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- McMaster Immunology Research Centre, Hamilton, ON, Canada
| | - Matthew S Miller
- McMaster Immunology Research Centre, Hamilton, ON, Canada
- Department of Biochemistry, McMaster University, Hamilton, ON, Canada
| | - Sasha Bernatsky
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Maggie J Larché
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
- McMaster Immunology Research Centre, Hamilton, ON, Canada.
| | - Dawn M E Bowdish
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
- McMaster Immunology Research Centre, Hamilton, ON, Canada.
- Firestone Institute of Respiratory Health, St. Joseph's Healthcare, Hamilton, ON, Canada.
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29
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Butt IN, van Eeden C, Kovacs Burns K, Saxinger L, Clifford A, Redmond D, Cohen Tervaert JW, Yacyshyn E. Understanding COVID-19 vaccine hesitancy in vasculitis patients. Front Public Health 2023; 11:1301492. [PMID: 38111485 PMCID: PMC10726054 DOI: 10.3389/fpubh.2023.1301492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Objective To identify the factors that impact COVID-19 vaccine decision-making in vaccine-hesitant vasculitis patients, and compare their perceptions with other rheumatology patients, given existence of data suggesting rheumatology patients may have disease-specific factors that influence their COVID-19 vaccine decision-making. Methods This cross-sectional study surveyed adult rheumatology patients from the Kaye Edmonton Clinic Rheumatology Clinic, in Canada, between June and August 2021, using an anonymous online questionnaire. Survey responses were analyzed for statistical differences using chi-square analysis. Results The COVID-19 Vaccine Perceptions Survey had a response rate of 70.9%. Of the total 231 respondents, 103 patients were diagnosed with vasculitis. At the time of the survey, 10.6% of vasculitis patients refused to receive a COVID-19 vaccine compared to 6.3% for other rheumatology patients. Compared to other rheumatology patients, vaccine-hesitant vasculitis patients were significantly more concerned about almost every aspect of available COVID-19 vaccines [e.g., safety (p < 0.001), components (p < 0.001)], and feared that they could contract SARS-CoV-2 from a vaccine (p < 0.001). These vaccine-hesitant patients were also significantly less pleased with the government's pandemic response, less confident in healthcare team-provided information (p < 0.001), and more likely to report that healthcare providers had no role in their COVID-19 vaccine decision-making (p < 0.001). Conclusion Vaccine-hesitant vasculitis patients may have multiple considerations influencing COVID-19 vaccine hesitancy, including vaccine and disease-specific concerns, along with unfavorable perceptions of the healthcare system (government and healthcare providers). Healthcare providers can address some of these concerns by initiating patient-centered discussions around immunizations to help support educated decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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30
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Papagoras C, Zioga N, Papadopoulos V, Gerolymatou N, Kalavri E, Bounos C, Simopoulou T, Fragoulis GE, Panopoulos S, Fragiadaki K, Evangelatos G, Bournia VK, Arida A, Karamanakos A, Pappa M, Kravvariti E, Deftereou K, Kougkas N, Zampeli E, Kataxaki E, Melissaropoulos K, Barouta G, Panagiotopoulos A, Koutsianas C, Liossis SN, Georgiou P, Dimitroulas T, Tektonidou MG, Bogdanos DP, Elezoglou A, Voulgari PV, Sfikakis PP, Vassilopoulos D. Omicron variant dominance and anti-SARS-CoV-2 vaccination are key determinants for a milder course of COVID-19 in patients with systemic autoimmune rheumatic diseases. Clin Rheumatol 2023; 42:3375-3385. [PMID: 37731083 PMCID: PMC10640401 DOI: 10.1007/s10067-023-06769-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION This study aimed to determine whether the introduction of anti-SARS-CoV-2 vaccines and the dominance of the omicron variant had a significant impact on the outcome of COVID-19 in patients with systemic autoimmune rheumatic diseases (SAIRDs). METHODS Using data entered to the Greek Rheumatology Society COVID-19 registry, we investigated the incidence of hospitalization and death due to COVID-19, during the successive periods of the pandemic according to the prevalent strain (wild-type, Alpha, Delta, Omicron) in vaccinated and unvaccinated patients. Variables independently associated with hospitalization and death were explored using multivariate regression analyses, while Kaplan-Meier curves were used to depict survival data. RESULTS From August 2020 until June 30, 2022, 456 cases (70.2% females) of COVID-19 with a mean age (± SD) of 51.4 ± 14.0 years were reported. In unvaccinated patients, the proportions of hospitalization and death were 24.5% and 4%, compared to 12.5% and 0.8% in the vaccinated group (p < 0.001 for both comparisons). The rates of hospitalization for the wild-type, Alpha, Delta, and Omicron periods were 24.7%, 31.3%, 25.9%, and 8.1% respectively (p < 0.0001), while the case fatality rates were 2.7%, 4%, 7%, and 0%, respectively (p = 0.001). Using multivariable regression analysis, factors independently associated with hospitalization were infection by a non-Omicron variant, being non-vaccinated, exposure to rituximab, older age, and respiratory and cardiovascular disease. Independent predictors for death were contracting COVID-19 during the Alpha or Delta period, pulmonary disease, and older age, while being vaccinated was protective. CONCLUSIONS In this 2-year analysis, the rates of hospitalization and death among patients with SAIRDs have declined significantly. Vaccination and the dominance of the Omicron variant appear to be the major determinants for this shift. Key points • During the late phase of the pandemic, the proportion of severe COVID-19 cases, defined as requiring hospitalization or resulting in death, in patients with systemic autoimmune rheumatic diseases has declined. • Anti-SARS-CoV-2 vaccination and the dominance of the Omicron strain are the key factors that have independently contributed to this shift.
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Affiliation(s)
- Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikoleta Zioga
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Nafsika Gerolymatou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni Kalavri
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Christos Bounos
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Theodora Simopoulou
- Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
| | - George E Fragoulis
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Panopoulos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Fragiadaki
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Evangelatos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Arida
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Karamanakos
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evrydiki Kravvariti
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleopatra Deftereou
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kougkas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Evangelia Kataxaki
- Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece
| | | | | | - Alexandros Panagiotopoulos
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece
| | - Christos Koutsianas
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece
| | - Stamatis-Nick Liossis
- Division of Rheumatology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria G Tektonidou
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios P Bogdanos
- Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
| | - Antonia Elezoglou
- Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Petros P Sfikakis
- 1st Department of Propedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 115 27, Athens, Greece.
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31
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Yang Y, Du T, Yu W, Zhou Y, Yang C, Kuang D, Wang J, Tang C, Wang H, Zhao Y, Yang H, Huang Q, Wu D, Li B, Sun Q, Liu H, Lu S, Peng X. Single-cell transcriptomic atlas of distinct early immune responses induced by SARS-CoV-2 Proto or its variants in rhesus monkey. MedComm (Beijing) 2023; 4:e432. [PMID: 38020713 PMCID: PMC10661830 DOI: 10.1002/mco2.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Immune responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection play a critical role in the pathogenesis and outcome of coronavirus disease 2019 (COVID-19). However, the dynamic profile of immune responses postinfection by SARS-CoV-2 variants of concern (VOC) is not fully understood. In this study, peripheral blood mononuclear cells single-cell sequencing was performed to determine dynamic profiles of immune response to Prototype, Alpha, Beta, and Delta in a rhesus monkey model. Overall, all strains induced dramatic changes in both cellular subpopulations and gene expression levels at 1 day postinfection (dpi), which associated function including adaptive immune response, innate immunity, and IFN response. COVID-19-related genes revealed different gene profiles at 1 dpi among the four SARS-CoV-2 strains, including genes reported in COVID-19 patients with increased risk of autoimmune disease and rheumatic diseases. Delta-infected animal showed inhibition of translation pathway. B cells, T cells, and monocytes showed much commonality rather than specificity among the four strains. Monocytes were the major responders to SARS-CoV-2 infection, and the response lasted longer in Alpha than the other strains. Thus, this study reveals the early immune responses induced by SARS-CoV-2 Proto or its variants in nonhuman primates, which is important information for controlling rapidly evolving viruses.
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Affiliation(s)
- Yun Yang
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Tingfu Du
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Wenhai Yu
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Yanan Zhou
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Chengyun Yang
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Dexuan Kuang
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Junbin Wang
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Cong Tang
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Haixuan Wang
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Yuan Zhao
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Hao Yang
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Qing Huang
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Daoju Wu
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Bai Li
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
| | - Qiangming Sun
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College)Ministry of EducationBeijingChina
| | - Hongqi Liu
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College)Ministry of EducationBeijingChina
| | - Shuaiyao Lu
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College)Ministry of EducationBeijingChina
| | - Xiaozhong Peng
- National Kunming High‐level Biosafety Primate Research Center, Institute of Medical BiologyChinese Academy of Medical Sciences and Peking Union Medical SchoolKunmingChina
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College)Ministry of EducationBeijingChina
- State Key Laboratory of Medical Molecular BiologyDepartment of Molecular Biology and BiochemistryInstitute of Basic Medical SciencesMedical Primate Research CenterNeuroscience CenterChinese Academy of Medical SciencesSchool of Basic MedicinePeking Union Medical CollegeBeijingChina
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Schneeweiss-Gleixner M, Hillebrand C, Jaksits S, Fries J, Zauner M, Heinz G, Sengölge G, Staudinger T, Zauner C, Aletaha D, Machold KP, Schellongowski P, Bécède M. Characteristics and outcome of critically ill patients with systemic rheumatic diseases referred to the intensive care unit. RMD Open 2023; 9:e003287. [PMID: 38030230 PMCID: PMC10689389 DOI: 10.1136/rmdopen-2023-003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Patients with systemic rheumatic diseases (SRDs) are at risk of admission to the intensive care unit (ICU). Data concerning these critically ill patients are limited to few retrospective studies. METHODS This is a single-centre retrospective study of patients with SRDs admitted to an ICU at the Vienna General Hospital between 2012 and 2020. Single-predictor and multiple logistic regression analysis was performed to identify potential outcome determinants. RESULTS A total of 144 patients accounting for 192 ICU admissions were included. Connective tissue diseases (CTDs), vasculitides and rheumatoid arthritis were the most common SRDs requiring ICU admission. Leading causes for ICU admission were respiratory failure and shock, as reflected by a high number of patients requiring mechanical ventilation (60.4%) and vasopressor therapy (72.9%). Overall, 29.2% of admissions were due to SRD-related critical illness. In 70.8% patients, co-existent SRD not responsible for the acute critical illness was documented. When comparing these subgroups, CTDs and vasculitides had a higher frequency in the patients with SRD-related critical illness. In a significantly higher proportion of patients in the SRD-related subgroup, diagnosis of SRD was made at the ICU. ICU and 6-month mortality in the overall population was 20.3% and 38.5%, respectively. Age, glucocorticoid therapy prior to hospital admission and disease severity were associated with poor outcome. CONCLUSIONS In this study, respiratory failure was the leading cause of ICU admission as reflected by high rates of required mechanical ventilation. Despite considerable severity of critical illness, survival rates were comparable to a general ICU population.
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Affiliation(s)
- Mathias Schneeweiss-Gleixner
- Clinical Division of Gastroenterology and Hepatology, Department of Medicine III, Intensive Care Unit 13.h1, Medical University of Vienna, Vienna, Austria
| | - Caroline Hillebrand
- Clinical Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Stephanie Jaksits
- Clinical Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jonathan Fries
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Michael Zauner
- Clinical Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Clinical Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gürkan Sengölge
- Clinical Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Intensive Care Unit 13.i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Clinical Division of Gastroenterology and Hepatology, Department of Medicine III, Intensive Care Unit 13.h1, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Clinical Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Klaus P Machold
- Clinical Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Intensive Care Unit 13.i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Manuel Bécède
- Clinical Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Lower Austrian Centre for Rheumatology, Department of Medicine II, State Hospital Stockerau, Stockerau, Austria
- Karl Landsteiner Institute for Clinical Rheumatology, Stockerau, Austria
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Picchianti-Diamanti A, Navarra A, Aiello A, Laganà B, Cuzzi G, Salmi A, Vanini V, Maggi F, Meschi S, Matusali G, Notari S, Agrati C, Salemi S, Di Rosa R, Passarini D, Di Gioia V, Sesti G, Conti F, Spinelli FR, Corpolongo A, Chimenti MS, Ferraioli M, Sebastiani GD, Benucci M, Li Gobbi F, Santoro AP, Capri A, Puro V, Nicastri E, Goletti D. Older Age, a High Titre of Neutralising Antibodies and Therapy with Conventional DMARDs Are Associated with Protection from Breakthrough Infection in Rheumatoid Arthritis Patients after the Booster Dose of Anti-SARS-CoV-2 Vaccine. Vaccines (Basel) 2023; 11:1684. [PMID: 38006015 PMCID: PMC10675674 DOI: 10.3390/vaccines11111684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Objectives: We aimed to analyse the incidence and severity of breakthrough infections (BIs) in rheumatoid arthritis (RA) patients after a COronaVIrus Disease 2019 (COVID-19) vaccination booster dose. Methods: We enrolled 194 RA patients and 1002 healthcare workers (HCWs) as controls. Clinical, lifestyle and demographic factors were collected at the time of the third dose, and immunogenicity analyses were carried out in a subgroup of patients at 4-6 weeks after the third dose. Results: BIs were experienced by 42% patients (82/194) with a median time since the last vaccination of 176 days. Older age (>50 years; aHR 0.38, 95% CI: 0.20-0.74), receiving conventional synthetic disease modifying antirheumatic drugs (csDMARDs) (aHR 0.52, 95%CI: 0.30-0.90) and having a titre of neutralising antibodies >20 (aHR 0.36, 95% CI: 0.12-1.07) were identified as protective factors. Conversely, anti-IL6R treatment and anti-CD20 therapy increased BI probability. BIs were mostly pauci-symptomatic, but the hospitalisation incidence was significantly higher than in HCWs (8.5% vs. 0.19%); the main risk factor was anti-CD20 therapy. Conclusions: Being older than 50 years and receiving csDMARDs were shown to be protective factors for BI, whereas anti-IL6R or anti-CD20 therapy increased the risk. Higher neutralising antibody titres were associated with a lower probability of BI. If confirmed in a larger population, the identification of a protective cut-off would allow a personalised risk-benefit therapeutic management of RA patients.
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Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Assunta Navarra
- Epidemiology Department, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy;
| | - Alessandra Aiello
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Andrea Salmi
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
| | - Valentina Vanini
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
- Unità Operativa Semplice (UOS) Professioni Sanitarie Tecniche, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (F.M.); (S.M.); (G.M.)
| | - Stefania Notari
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.N.); (C.A.)
| | - Chiara Agrati
- Laboratory of Cellular Immunology and Clinical Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.N.); (C.A.)
- Department of Pediatric Hematology and Oncology, Bambino Gesù Pediatric Hospital, 00152 Rome, Italy
| | - Simonetta Salemi
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Roberta Di Rosa
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Damiano Passarini
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Valeria Di Gioia
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, “Sapienza” University, S. Andrea University Hospital, 00189 Rome, Italy; (A.P.-D.); (B.L.); (S.S.); (R.D.R.); (D.P.); (V.D.G.); (G.S.)
| | - Fabrizio Conti
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.C.); (F.R.S.)
| | - Francesca Romana Spinelli
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.C.); (F.R.S.)
| | - Angela Corpolongo
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.C.); (E.N.)
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of ‘Medicina dei Sistemi’, University of Rome ‘Tor Vergata’, 00133 Rome, Italy;
| | - Mario Ferraioli
- Department of Rheumatology, San Camillo Hospital, 00152 Rome, Italy; (M.F.); (G.D.S.)
| | | | - Maurizio Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL—Toscana Centro, 50122 Florence, Italy; (M.B.); (F.L.G.)
| | - Francesca Li Gobbi
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL—Toscana Centro, 50122 Florence, Italy; (M.B.); (F.L.G.)
| | - Anna Paola Santoro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Andrea Capri
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
| | - Vincenzo Puro
- UOC Emerging Infections and Centro di Riferimento AIDS (CRAIDS), National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.P.S.); (A.C.); (V.P.)
| | - Emanuele Nicastri
- Clinical Division of Infectious Diseases, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.C.); (E.N.)
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani—Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (A.A.); (G.C.); (A.S.); (V.V.)
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Kim YK, Kim JY, Jung JI, Park JK, Lee EY, Lee EB, Park JW. COVID-19 infection and efficacy of vaccination in patients with rheumatic diseases during Omicron outbreak in South Korea: a prospective cohort study. RMD Open 2023; 9:e003398. [PMID: 37973535 PMCID: PMC10660437 DOI: 10.1136/rmdopen-2023-003398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to investigate COVID-19 epidemiological data in patients with autoimmune inflammatory rheumatic diseases (AIRDs) during Omicron wave and to identify clinical factors associated with infection, including COVID-19 vaccination. METHODS This prospective longitudinal study was performed between January and October 2022 in South Korea. Patients were classified into AIRD and non-AIRD groups according to their underlying diseases. COVID-19 status, date of confirmed infection and vaccination status were captured from the patient survey and national database. The COVID-19 incidence during the study period was examined and compared between the two groups. The effect of clinical factors on the infection rate was analysed in the AIRD group. RESULTS A total of 1814 patients (1535 and 279 in the AIRD and non-AIRD groups, respectively) were analysed. During the study period, 857 COVID-19 cases were reported in 834 patients (46.0%). The infection rates in the AIRD and non-AIRD groups were comparable. In the AIRD group, older age (≥70 years) and glucocorticoid use were significantly associated with a lower rate of COVID-19 infection. The third booster vaccination significantly lowered the incidence of COVID-19 (adjusted HR 0.85 (95% CI 0.73 to 0.99)), and the prophylactic effect was more evident in patients aged <70 years (0.81 (95% CI 0.69 to 0.95), p value for interaction 0.036). CONCLUSION The risk of SARS-CoV-2 infection with the Omicron variant did not increase in patients with AIRDs. The third booster vaccination regimen decreased the infection rate in patients aged <70 years.
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Affiliation(s)
- Yun Kyu Kim
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Ju Yeon Kim
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Ji In Jung
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Jin Kyun Park
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Rheumatology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Eun Young Lee
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Rheumatology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Eun-Bong Lee
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Rheumatology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jun Won Park
- Rheumatology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Rheumatology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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35
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Onuora S. Pre-exposure prophylaxis reduces risk of COVID-19. Nat Rev Rheumatol 2023; 19:677. [PMID: 37789116 DOI: 10.1038/s41584-023-01039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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Bieber A, Brikman S, Novack L, Abuhasira R, Fawaz A, Abu-Shakra M, Zeller L, Ling E, Mader R, Sagy I. Fourth dose of BNT162b2 vaccine for patients with autoimmune rheumatic diseases in a nationwide setting. Rheumatology (Oxford) 2023; 62:3332-3338. [PMID: 36762825 DOI: 10.1093/rheumatology/kead064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE The effectiveness of COVID-19 vaccinations wanes due to immune evasion by the B.1.1.529 (Omicron) variant and diminished antibody titres over time. We aimed to evaluate the benefit of a fourth vaccination dose in patients with autoimmune rheumatic diseases (ARDs). METHODS This retrospective analysis included ARD patients aged 18 years or older and members of Clalit Health Services in Israel (which at the time of the study insured 52% of the entire population), and covered the period from 16 January 2022 to 31 March 2022, when the predominant SARS-CoV-2 variant was Omicron. We compared patients without previous COVID-19 infection who had received three doses of the BNT162b2 vaccine (the control group) with those who had received the fourth dose. The primary outcome was COVID-19 infection, which was analysed using multivariate Cox regression in the entire cohort and within ARD subgroups. Secondary outcomes were COVID-19-related hospitalizations and COVID-19-related death. RESULTS We included 43 748 ARD patients, of whom 27 766 and 15 982 were in the control and fourth vaccination groups, respectively. COVID-19 infection occurred in 6942 (25.0%) of the control group and 1754 (11.0%) of the fourth dose group (P < 0.001). Patients vaccinated with the fourth dose had a lower risk of COVID-19 infection than the entire cohort [Hazard Ratio (HR) 0.54, 95% CI 0.52, 0.58] and throughout every subgroup regardless of the baseline characteristic or medical treatment, except for rituximab. A similar association was observed for risk of COVID-19-related hospitalization (HR 0.36, 95% CI 0.22, 0.61) and of COVID-19-related death (HR 0.41, 95% CI 0.24, 0.71). CONCLUSION A fourth BNT162b2 vaccination of ARD patients was associated with favourable outcomes compared with three doses among patients with no history of COVID-19 infection.
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Affiliation(s)
- Amir Bieber
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
| | - Shay Brikman
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Ran Abuhasira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine B, Rabin Medical Centre, Beilinson Campus, Petah Tikva, Israel
| | - Abdallah Fawaz
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
| | - Mahmoud Abu-Shakra
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Zeller
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eduard Ling
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Reuven Mader
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Sen P, R N, Houshmand N, Moghadam Kia S, Joshi M, Saha S, Jagtap K, Agarwal V, Nune A, Nikiphorou E, Tan AL, Shinjo SK, Ziade N, Velikova T, Milchert M, Parodis I, Gracia-Ramos AE, Cavagna L, Kuwana M, Knitza J, Makol A, Patel A, Pauling JD, Wincup C, Barman B, Zamora Tehozol EA, Rojas Serrano J, García-De La Torre I, Colunga-Pedraza IJ, Merayo-Chalico J, Chibuzo OC, Katchamart W, Akawatcharangura Goo P, Shumnalieva R, Chen YM, Hoff LS, El Kibbi L, Halabi H, Vaidya B, Sazliyana Shaharir S, Hasan ATMT, Dey D, Gutiérrez CET, Caballero-Uribe CV, Lilleker JB, Salim B, Gheita T, Chatterjee T, Distler O, Saavedra MA, Day J, Chinoy H, Agarwal V, Aggarwal R, Gupta L. Vaccine hesitancy decreases in rheumatic diseases, long-term concerns remain in myositis: a comparative analysis of the COVAD surveys. Rheumatology (Oxford) 2023; 62:3291-3301. [PMID: 36734536 DOI: 10.1093/rheumatology/kead057] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE COVID-19 vaccines have a favorable safety profile in patients with autoimmune rheumatic diseases (AIRDs) such as idiopathic inflammatory myopathies (IIMs); however, hesitancy continues to persist among these patients. Therefore, we studied the prevalence, predictors and reasons for hesitancy in patients with IIMs, other AIRDs, non-rheumatic autoimmune diseases (nrAIDs) and healthy controls (HCs), using data from the two international COVID-19 Vaccination in Autoimmune Diseases (COVAD) e-surveys. METHODS The first and second COVAD patient self-reported e-surveys were circulated from March to December 2021, and February to June 2022 (ongoing). We collected data on demographics, comorbidities, COVID-19 infection and vaccination history, reasons for hesitancy, and patient reported outcomes. Predictors of hesitancy were analysed using regression models in different groups. RESULTS We analysed data from 18 882 (COVAD-1) and 7666 (COVAD-2) respondents. Reassuringly, hesitancy decreased from 2021 (16.5%) to 2022 (5.1%) (OR: 0.26; 95% CI: 0.24, 0.30, P < 0.001). However, concerns/fear over long-term safety had increased (OR: 3.6; 95% CI: 2.9, 4.6, P < 0.01). We noted with concern greater skepticism over vaccine science among patients with IIMs than AIRDs (OR: 1.8; 95% CI: 1.08, 3.2, P = 0.023) and HCs (OR: 4; 95% CI: 1.9, 8.1, P < 0.001), as well as more long-term safety concerns/fear (IIMs vs AIRDs - OR: 1.9; 95% CI: 1.2, 2.9, P = 0.001; IIMs vs HCs - OR: 5.4 95% CI: 3, 9.6, P < 0.001). Caucasians [OR 4.2 (1.7-10.3)] were likely to be more hesitant, while those with better PROMIS physical health score were less hesitant [OR 0.9 (0.8-0.97)]. CONCLUSION Vaccine hesitancy has decreased from 2021 to 2022, long-term safety concerns remain among patients with IIMs, particularly in Caucasians and those with poor physical function.
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Affiliation(s)
- Parikshit Sen
- Maulana Azad Medical College, New Delhi, Delhi, India
| | - Naveen R
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Nazanin Houshmand
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Siamak Moghadam Kia
- Myositis Center and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Sreoshy Saha
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - Kshitij Jagtap
- Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, Maharashtra, India
| | - Vishwesh Agarwal
- Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
| | - Arvind Nune
- Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
- Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | | | - Marcin Milchert
- Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lorenzo Cavagna
- Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia, Pavia, Lombardy, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Johannes Knitza
- Medizinische Klinik 3-Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Aarat Patel
- Bon Secours Rheumatology Center and Division of Pediatric Rheumatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John D Pauling
- Bristol Medical School Translational Health Sciences, University of Bristol, UK
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Chris Wincup
- Department of Rheumatology, Division of Medicine, Rayne Institute, University College London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH, GOSH, London, UK
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
| | - Erick Adrian Zamora Tehozol
- Rheumatology, Medical Care & Research, Centro Medico Pensiones Hospital, Instituto Mexicano del Seguro Social Delegación Yucatán, Yucatán, Mexcio
| | - Jorge Rojas Serrano
- Rheumatologist and Clinical Investigator, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Ignacio García-De La Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente and Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Okwara Celestine Chibuzo
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla/University of Nigeria, Enugu, Nigeria
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Russka Shumnalieva
- Department of Rheumatology, Clinic of Rheumatology, University Hospital 'St. Ivan Rilski', Medical University-Sofia, Bulgaria
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Lina El Kibbi
- Rheumatology Unit, Internal Medicine Department, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Internal Medicine, Section of Rheumatology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Binit Vaidya
- National Center for Rheumatic Diseases (NCRD), Kathmandu, Nepal
| | | | - A T M Tanveer Hasan
- Department of Rheumatology, Enam Medical College & Hospital, Dhaka, Bangladesh
| | - Dzifa Dey
- Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | | | | | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Babur Salim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Tulika Chatterjee
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Miguel A Saavedra
- Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC , Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Latika Gupta
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Hirai J, Mori N, Sakanashi D, Ohashi W, Shibata Y, Asai N, Kato H, Hagihara M, Mikamo H. Real-World Experience of the Comparative Effectiveness and Safety of Combination Therapy with Remdesivir and Monoclonal Antibodies versus Remdesivir Alone for Patients with Mild-to-Moderate COVID-19 and Immunosuppression: A Retrospective Single-Center Study in Aichi, Japan. Viruses 2023; 15:1952. [PMID: 37766358 PMCID: PMC10538070 DOI: 10.3390/v15091952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic continues to threaten global public health. Remdesivir and monoclonal antibodies have shown promise for COVID-19 treatment of patients who are immunocompromised, including those with cancer, transplant recipients, and those with autoimmune disorder. However, the effectiveness and safety of this combination therapy for patients who are immunosuppressed remain unclear. We compared the efficacy and safety of combination therapy and remdesivir monotherapy for patients with mild-to-moderate COVID-19 who were immunosuppressed. Eighty-six patients treated in July 2021-March 2023 were analyzed. The combination therapy group (CTG) showed a statistically significant reduction in viral load compared with the monotherapy group (MTG) (p < 0.01). Patients in the CTG also experienced earlier resolution of fever than those in the MTG (p = 0.02), although this difference was not significant in the multivariate analysis (p = 0.21). Additionally, the CTG had significantly higher discharge rates on days 7, 14, and 28 than the MTG (p < 0.01, p < 0.01, and p = 0.04, respectively). No serious adverse events were observed with combination therapy. These findings suggest that combination therapy may improve the clinical outcomes of immunosuppressed COVID-19 patients by reducing the viral load and hastening recovery. Further studies are required to fully understand the benefits of this combination therapy for immunocompromised COVID-19 patients.
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Affiliation(s)
- Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (J.H.); (N.M.); (N.A.)
- Department of Infection, Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (D.S.); (Y.S.)
| | - Nobuaki Mori
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (J.H.); (N.M.); (N.A.)
- Department of Infection, Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (D.S.); (Y.S.)
| | - Daisuke Sakanashi
- Department of Infection, Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (D.S.); (Y.S.)
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan;
| | - Yuichi Shibata
- Department of Infection, Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (D.S.); (Y.S.)
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (J.H.); (N.M.); (N.A.)
- Department of Infection, Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (D.S.); (Y.S.)
| | - Hideo Kato
- Department of Pharmacy, Mie University Hospital, 2-174 Edobashi, Tsu-shi 514-8507, Mie, Japan;
| | - Mao Hagihara
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan;
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (J.H.); (N.M.); (N.A.)
- Department of Infection, Prevention and Control, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute-shi 480-1195, Aichi, Japan; (D.S.); (Y.S.)
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Adas MA, Russell MD, Cook E, Alveyn E, Hannah J, Balachandran S, Oyebanjo S, Amlani-Hatcher P, Ledingham J, Norton S, Galloway JB. COVID-19 admissions and mortality in patients with early inflammatory arthritis: results from a UK national cohort. Rheumatology (Oxford) 2023; 62:2979-2988. [PMID: 36645234 PMCID: PMC10473194 DOI: 10.1093/rheumatology/kead018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To describe the risks and predictors of coronavirus disease 2019 (COVID-19) hospitalization and mortality among patients with early inflammatory arthritis (EIA), recruited to the National Early Inflammatory Arthritis Audit (NEIAA). METHODS NEIAA is an observational cohort. We included adults with EIA from Feb 2020 to May 2021. Outcomes of interest were hospitalization and death due to COVID-19, using NHS Digital linkage. Cox proportional hazards were used to calculate hazard ratios for outcomes according to initial treatment strategy, with adjustment for confounders. RESULTS From 14 127 patients with EIA, there were 143 hospitalizations and 47 deaths due to COVID-19, with incidence rates per 100 person-years of 0.93 (95% CI 0.79, 1.10) for hospitalization and 0.30 (95% CI 0.23, 0.40) for death. Increasing age, male gender, comorbidities and ex-smoking were associated with increased risk of worse COVID-19 outcomes. Higher baseline DAS28 was not associated with COVID-19 admissions [confounder adjusted hazard ratio (aHR) 1.10; 95% CI 0.97, 1.24] or mortality (aHR 1.11; 95% CI 0.90, 1.37). Seropositivity was not associated with either outcome. Higher symptom burden on patient-reported measures predicted worse COVID-19 outcomes. In unadjusted models, CS associated with COVID-19 death (HR 2.29; 95% CI 1.02, 5.13), and SSZ monotherapy associated with COVID-19 admission (HR 1.92; 95% CI 1.04, 3.56). In adjusted models, associations for CS and SSZ were not statistically significant. CONCLUSION Patient characteristics have stronger associations with COVID-19 than the initial treatment strategy in patients with EIA. An important limitation is that we have not looked at treatment changes over time.
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Affiliation(s)
- Maryam A Adas
- Centre for Rheumatic Disease, King’s College London, London, UK
| | - Mark D Russell
- Centre for Rheumatic Disease, King’s College London, London, UK
| | - Emma Cook
- Centre for Rheumatic Disease, King’s College London, London, UK
| | - Edward Alveyn
- Centre for Rheumatic Disease, King’s College London, London, UK
| | - Jennifer Hannah
- Centre for Rheumatic Disease, King’s College London, London, UK
| | | | | | | | - Joanna Ledingham
- Rheumatology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sam Norton
- Centre for Rheumatic Disease, King’s College London, London, UK
- Psychology Department, Institute for Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Brooks J, Montgomery A, Dalbeth N, Sapsford M, Ngan Kee R, Cooper A, Quincey V, Bhana S, Gore-Massy M, Hausmann J, Liew J, Machado PM, Sufka P, Sirotich E, Robinson P, Wallace Z, Yazdany J, Grainger R. Omicron variant infection in inflammatory rheumatological conditions - outcomes from a COVID-19 naive population in Aotearoa New Zealand. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100843. [PMID: 37520279 PMCID: PMC10372177 DOI: 10.1016/j.lanwpc.2023.100843] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023]
Abstract
Background Due to geographic isolation and border controls Aotearoa New Zealand (AoNZ) attained high levels of population coronavirus disease-19 (COVID-19) vaccination before widespread transmission of COVID-19. We describe outcomes of SARS-CoV-2 infection (Omicron variant) in people with inflammatory rheumatic diseases in this unique setting. Methods This observational study included people with inflammatory rheumatic disease and SARS-CoV-2 infection in AoNZ between 1 February and 30 April 2022. Data were collected via the Global Rheumatology Alliance Registry including demographic and rheumatic disease characteristics, and COVID-19 vaccination status and outcomes. Multivariable logistic regression was used to explore associations of demographic and clinical factors with COVID-19 hospitalisation and death. Findings Of the 1599 cases included, 96% were from three hospitals that systematically identified people with inflammatory rheumatic disease and COVID-19. At time of COVID-19, 1513 cases (94.6%) had received at least two COVID-19 vaccinations. Hospitalisation occurred for 104 (6.5%) cases and 10 (0.6%) patients died. Lower frequency of hospitalisation was seen in cases who had received at least two vaccinations (5.9%), compared to the unvaccinated (20.6%) or those with a single vaccine dose (10.7%). In multivariable adjusted models, people with gout or connective tissue diseases (CTD) had increased risk of the combined outcome of hospitalisation/death, compared to people with inflammatory arthritis. Glucocorticoid and rituximab use were associated with increased rates of hospitalisation/death. All patients who died had three or more co-morbidities or were over 60 years old. Interpretation In this cohort with inflammatory rheumatic diseases and high vaccination rates, severe outcomes from SARS-CoV-2 Omicron variant were relatively infrequent. The outcome of Omicron variant infection among vaccinated but SARS-CoV-2 infection-naive people with inflammatory rheumatic disease without other known risk factors were favourable. Funding Financial support from the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) included management of COVID-19 Global Rheumatology Alliance funds.
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Affiliation(s)
- Jonathon Brooks
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Anna Montgomery
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, New Zealand
| | - Mark Sapsford
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Rachel Ngan Kee
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Amy Cooper
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Vicki Quincey
- Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | | | | | - Jonathan Hausmann
- Program in Rheumatology, Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pedro M. Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | | | - Philip Robinson
- University of Queensland School of Clinical Medicine, Herston, Queensland, Australia
- Department of Rheumatology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Zachary Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, New Zealand
- Te Whatu Ora Health New Zealand Capital Coast and Hutt, Wellington, New Zealand
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Jain V, Shobha V, Kumar S, Janardana R, Selvam S. Comparison of Risk Factors During First and Second Wave of COVID-19 in Patients with Autoimmune Rheumatic Diseases (AIRD): Results from KRACC Subset. Mediterr J Rheumatol 2023; 34:342-348. [PMID: 37941863 PMCID: PMC10628883 DOI: 10.31138/mjr.20230827.co] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 11/10/2023] Open
Abstract
Background The differential influence and outcome of various risk factors on occurrence of COVID-19 among patients with autoimmune rheumatic diseases (AIRD) during different COVID-19 peaks is underreported. Aim To assess the impact and outcome of conventional risk factors, immunosuppressants, and comorbidities on the risk of COVID-19 among AIRD patients during the first two COVID-19 peaks. Design Prospective, non-interventional longitudinal cohort study. Methods This is a subset of the KRA COVID19 cohort undertaken during the initial wave of COVID-19 (W1) (Apr-Dec2021); and the 2nd-wave (W2) (Jan-Aug2021). Data collected included description of AIRD subsets, treatment characteristics, comorbidities, and COVID-19 occurrence. Risk factors associated with mortality were analysed. The incidence rate was compared with that of the general population in the same geographic region. Results AIRD patients (n=2969) had a higher incidence of COVID-19 in the W2 (7.1%) than in the W1 (1.7%) as compared to the general population (Government bulletin). Age (p<0.01) and duration of AIRD (p<0.001) influenced COVID-19 occurrence in W2 while major disease subsets and immunosuppressants including glucocorticoids did not. The W2 had lower HCQ usage (Adjusted Odds Ratio [AOR]-0.81) and comorbidities like hypertension (AOR -0.54) and pre-existing lung disease (AOR -0.38;0.19-0.75) compared to W1. Older age (1.11) and coexistent diabetes mellitus (AOR 6.74) were independent risk factors associated with mortality in W2. Conclusions We report 1.7 times higher occurrence, and no influence of major disease subsets or immunosuppressants including glucocorticoids on COVID-19. Age and diabetes were independent risk factors for mortality.
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Affiliation(s)
- Vikramraj Jain
- Clinical Immunology, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India
| | - Vineeta Shobha
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Sharath Kumar
- Department of Rheumatology, Optima Arthritis and Rheumatology Clinic, Bengaluru, Karnataka, India
| | - Ramya Janardana
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Sumithra Selvam
- Division of Epidemiology and Biostatistics, St. John’s Research Institute, St. John’s Medical College Hospital, Bengaluru, Karnataka, India
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Koo M, Lu MC. Rheumatic Diseases: New Progress in Clinical Research and Pathogenesis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1581. [PMID: 37763699 PMCID: PMC10534296 DOI: 10.3390/medicina59091581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
Rheumatic diseases encompass a group of disorders that primarily target the musculoskeletal system, including joints, bones, muscles, and connective tissue [...].
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Affiliation(s)
- Malcolm Koo
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 970302, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi 622401, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
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Zhu K, Tsai O, Chahal D, Hussaini T, Yoshida EM. COVID-19 and Liver Disease: An Evolving Landscape. Semin Liver Dis 2023; 43:351-366. [PMID: 37604206 DOI: 10.1055/a-2157-3318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
The COVID-19 pandemic has resulted in significant worldwide morbidity and mortality. In this review, we examine the intricate relationships between COVID-19 and liver diseases. While respiratory manifestations of COVID-19 are well known, its impact and consequences in patients with liver diseases remain an area of ongoing investigation. COVID-19 can induce liver injury through various mechanisms and is associated with higher mortality in individuals with preexisting chronic liver disease. Mortality increases with the severity of chronic liver disease and the level of care required. The outcomes in patients with autoimmune hepatitis remain unclear, whereas liver transplant recipients are more likely to experience symptomatic COVID-19 but have comparable outcomes to the general population. Despite suboptimal immunological response, COVID-19 vaccinations are safe and effective in liver disease, although cases of autoimmune hepatitis-like syndrome have been reported. In conclusion, COVID-19 has significant implications in liver diseases; early recognition and treatments are important for improving patient outcomes.
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Affiliation(s)
- Kai Zhu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olivia Tsai
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daljeet Chahal
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Liver Transplant Program, Vancouver, British Columbia, Canada
| | - Trana Hussaini
- BC Liver Transplant Program, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Liver Transplant Program, Vancouver, British Columbia, Canada
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Ughi N, Bernasconi DP, Gagliardi C, Del Gaudio F, Dicuonzo A, Maloberti A, Giannattasio C, Rossetti C, Valsecchi MG, Epis OM. Trends in severe outcomes in SARS-CoV-2-positive hospitalized patients with rheumatic diseases: a monocentric observational and case-control study in northern Italy. Reumatismo 2023; 75. [PMID: 37462130 DOI: 10.4081/reumatismo.2023.1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 07/20/2023] Open
Abstract
Rheumatic disease patients are at greater risk of infection due to their disease, comorbidities, and immunosuppressive therapy. COVID-19 outcomes in this patient setting appeared to be similar to those of the general population. However, data on this topic were mainly related to small studies on a limited number of patients. Consequently, to date, this field remains poorly explored, particularly in the pre-vaccine era. This monocentric study aimed to describe the intrahospital mortality in rheumatic patients with SARS-CoV-2 consecutively hospitalized from 21 February to 31 December 2020, before anti-SARS-CoV-2 vaccine administration spread, compared with non-rheumatic patients. Of 2491 included patients, 65 [3%, median (interquartile range) age 75 (64.76-82.239 years, 65% women] were suffering from rheumatic diseases. A total of 20 deaths were reported [case fatality rate 31%, 95% confidence interval (CI): 19-42] compared with 433 deaths (19%, 95% CI: 17-20) in patients without rheumatic diseases (p=0.024). However, the rheumatic disease was not associated with a significant increase in univariate mortality hazards (hazard ratio 1.374, 95% CI: 0.876-2.154), and after adjustment (hazard ratio 1.199, 95% CI: 0.759-1.894) by age, sex and Charlson comorbidity index. The incidence of intensive care unit admission, death, and discharge in the case-control study was comparable between rheumatic and non-rheumatic patients. The presence of rheumatic diseases in SARS-CoV-2-hospitalized patients did not represent an independent risk factor for severe disease or mortality.
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Affiliation(s)
- N Ughi
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
| | - D P Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center-B4, School of Medicine and Surgery, Milano-Bicocca University, Milan.
| | - C Gagliardi
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
| | - F Del Gaudio
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - A Dicuonzo
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - A Maloberti
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan; School of Medicine and Surgery, Milano-Bicocca University, Milan .
| | - C Giannattasio
- Division of Cardiology 4, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan; School of Medicine and Surgery, Milano-Bicocca University, Milan .
| | - C Rossetti
- Functional Department for Higher Education, Research, and Development, Niguarda Hospital, Milan.
| | - M G Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center-B4, School of Medicine and Surgery, Milano-Bicocca University, Milan.
| | - O M Epis
- Division of Rheumatology, Multispecialist Medical Department, Niguarda Hospital, Milan.
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Naveen R, Nikiphorou E, Joshi M, Sen P, Lindblom J, Agarwal V, Lilleker JB, Tan AL, Salim B, Ziade N, Velikova T, Gracia-Ramos AE, Kuwana M, Day J, Makol A, Distler O, Chinoy H, Traboco LS, Wibowo SAK, Tehozol EAZ, Serrano JR, García-De La Torre I, Aggarwal R, Gupta L, Agarwal V, Parodis I. Safety and tolerance of vaccines against SARS-CoV-2 infection in systemic lupus erythematosus: results from the COVAD study. Rheumatology (Oxford) 2023; 62:2453-2463. [PMID: 36413073 PMCID: PMC10321116 DOI: 10.1093/rheumatology/keac661] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/10/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To determine COVID-19 vaccine-related adverse events (AEs) in the seven-day post-vaccination period in patients with SLE vs autoimmune rheumatic diseases (AIRDs), non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HC). METHODS Data were captured through the COVID-19 Vaccination in Autoimmune Diseases (COVAD) questionnaire (March-December 2021). Multivariable regression models accounted for age, gender, ethnicity, vaccine type and background treatment. RESULTS Among 9462 complete respondents, 583 (6.2%) were SLE patients (mean age: 40.1 years; 94.5% females; 40.5% Asian; 42.9% Pfizer-recipients). Minor AEs were reported by 83.0% of SLE patients, major by 2.6%, hospitalization by 0.2%. AE and hospitalization frequencies were similar between patients with active and inactive SLE. Rashes were more frequent in SLE patients vs HC (OR; 95% CI: 1.2; 1.0, 1.5), chills less frequent in SLE vs AIRDs (0.6; 0.4, 0.8) and nrAIDs (0.5; 0.3, 0.8), and fatigue less frequent in SLE vs nrAIDs (0.6; 0.4, 0.9). Pfizer-recipients reported higher overall AE (2.2; 1.1, 4.2) and injection site pain (2.9; 1.6, 5.0) frequencies than recipients of other vaccines, Oxford/AstraZeneca-recipients more body ache, fever, chills (OR: 2.5, 3.0), Moderna-recipients more body ache, fever, chills, rashes (OR: 2.6, 4.3). Hospitalization frequencies were similar across vaccine types. AE frequencies were similar across treatment groups, although chills were less frequent in antimalarial users vs non-users (0.5; 0.3, 0.9). CONCLUSION While COVID-19 vaccination-related AEs were reported by four-fifths of SLE patients, those were mostly minor and comparable to AEs reported by healthy individuals, providing reassurance regarding COVID-19 vaccination safety in SLE.
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Affiliation(s)
- R Naveen
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Parikshit Sen
- Maulana Azad Medical College, New Delhi, Delhi, India
| | - Julius Lindblom
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Vishwesh Agarwal
- Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
| | - James B Lilleker
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Babur Salim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
- Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Tsvetelina Velikova
- Department of Clinical Immunology, Medical Faculty, University Hospital 'Lozenetz', Sofia University St. Kliment Ohridski, Sofia, Bulgaria
| | - Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center, 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Hector Chinoy
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Lisa S Traboco
- Department of Medicine, Section of Rheumatology, St. Luke's Medical Center-Global City, Taguig, Philippines
| | - Suryo Anggoro Kusumo Wibowo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Jorge Rojas Serrano
- Rheumatologist and Clinical Investigator, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Ignacio García-De La Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente and University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Yousefi P, Soltani S, Siri G, Rezayat SA, Gholami A, Zafarani A, Razizadeh MH, Alborzi E, Mokhtary‐Irani G, Abedi B, Karampoor S, Tabibzadeh A, Farahani A. Coagulopathy and thromboembolic events a pathogenic mechanism of COVID-19 associated with mortality: An updated review. J Clin Lab Anal 2023; 37:e24941. [PMID: 37431777 PMCID: PMC10431412 DOI: 10.1002/jcla.24941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
During 2019, the SARS-CoV-2 emerged from China, and during months, COVID-19 spread in many countries around the world. The expanding data about pathogenesis of this virus could elucidate the exact mechanism by which COVID-19 caused death in humans. One of the pathogenic mechanisms of this disease is coagulation. Coagulation disorders that affect both venous and arterial systems occur in patients with COVID-19. The possible mechanism involved in the coagulation could be excessive inflammation induced by SARS-CoV-2. However, it is not yet clear well how SARS-CoV-2 promotes coagulopathy. However, some factors, such as pulmonary endothelial cell damage and some anticoagulant system disorders, are assumed to have an important role. In this study, we assessed conducted studies about COVID-19-induced coagulopathy to obtain clearer vision of the wide range of manifestations and possible pathogenesis mechanisms.
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Affiliation(s)
- Parastoo Yousefi
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Saber Soltani
- Department of Virology, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Goli Siri
- Department of Internal Medicine, Amir Alam HospitalTehran University of Medical SciencesTehranIran
| | - Sara Akhavan Rezayat
- Department of Health Care Management and Economics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Ali Gholami
- School of MedicineArak University of Medical SciencesArakIran
| | - Alireza Zafarani
- Department of Hematology and Blood Banking, Faculty of Allied MedicineIran University of Medical SciencesTehranIran
| | | | - Ehsan Alborzi
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Golnaz Mokhtary‐Irani
- Department of Virology, Faculty of MedicineAhvaz Jondishapur University of Medical SciencesAhvazIran
| | - Behnam Abedi
- Department of Medical Laboratory SciencesKhomein University of Medical SciencesKhomeinIran
| | - Sajad Karampoor
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
- Gastrointestinal and Liver Diseases Research CenterIran University of Medical SciencesTehranIran
| | - Alireza Tabibzadeh
- Department of Virology, School of MedicineIran University of Medical SciencesTehranIran
| | - Abbas Farahani
- Department of Medical Laboratory SciencesKhomein University of Medical SciencesKhomeinIran
- Molecular and Medicine Research CenterKhomein University of Medical SciencesKhomeinIran
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Prontskus V, Fresse A, Yelehe-Okouma M, Facile A, Pietri T, Simon C, Le Souder C, Beurrier M, Gillet P. COVID-19 Vaccination and the Incidence of De Novo or Recurrent Rheumatoid Arthritis: A French and International (VigiBase) Signal Detection Study. Clin Pharmacol Ther 2023; 113:1107-1116. [PMID: 36752604 DOI: 10.1002/cpt.2866] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
COVID-19 vaccination is critical in frequently immunocompromised patients with rheumatoid arthritis (RA). However, there is a question about the risk of RA flares following vaccination. Our study intended to find out about cases of new RA or flare-ups in people who already had RA that were reported in French and international pharmacovigilance databases after COVID-19 vaccination. We performed a "case-noncase" method in the international pharmacovigilance database VigiBase to identify the risk of RA following COVID-19 vaccination compared with other nonlive vaccines. Using the French Pharmacovigilance Database (FPVD), a descriptive analysis was carried out for RA cases after COVID-19 immunization and a multivariate logistic regression analysis was conducted to compare variables in the new-onset vs. flare-up groups. In 2021, 2,387 cases of RA were reported from 2,817,902 adverse drug reactions associated with COVID-19 vaccines recorded in VigiBase. The reporting odds ratio of RA onset with COVID-19 vaccines compared with the other nonlive vaccines was 0.66 (P < 0.0001). The FPVD reported 161 cases of RA with COVID-19 vaccines, including 77 new-onset RA and 84 cases of RA flare-up. In 88 cases (84.7%), RA occurred after the first dose. The mean time between vaccination and disease onset was 14 ± 21 days, and the delay was significantly shorter in the flare-up group. We do not show a higher risk of RA after COVID-19 vaccination compared with other nonlive vaccines in adults. De novo RA was more likely to happen quickly, be more severe, and have a worse outcome than flares in patients with RA.
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Affiliation(s)
- Viktoryia Prontskus
- Laboratoire de Pharmacologie-Toxicologie, Pharmacovigilance & Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance, Centre Hospitalier Régional et Universitaire de Nancy Brabois, Bâtiment de Biologie Médicale et de Biopathologie, Vandœuvre-Lès-Nancy, France
| | - Audrey Fresse
- Laboratoire de Pharmacologie-Toxicologie, Pharmacovigilance & Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance, Centre Hospitalier Régional et Universitaire de Nancy Brabois, Bâtiment de Biologie Médicale et de Biopathologie, Vandœuvre-Lès-Nancy, France
| | - Mélissa Yelehe-Okouma
- Laboratoire de Pharmacologie-Toxicologie, Pharmacovigilance & Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance, Centre Hospitalier Régional et Universitaire de Nancy Brabois, Bâtiment de Biologie Médicale et de Biopathologie, Vandœuvre-Lès-Nancy, France
| | - Anthony Facile
- Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France
| | - Tessa Pietri
- Centre Régional de Pharmacovigilance Marseille Provence Corse, Service de Pharmacologie Clinique & Pharmacovigilance, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université Institut National de la Santé et de la Recherche Médicale 1106, Marseille, France
| | - Corinne Simon
- Centre Régional de Pharmacovigilance, Service de Pharmacosurveillance, Centre Hospitalier Régional et Universitaire, Tours, France
| | - Cosette Le Souder
- Département de Pharmacologie Médicale et Toxicologie, Centre Régional de Pharmacovigilance Occitanie-Est, Le Centre Hospitalier et Universitaire de Montpellier, Montpellier, France
| | - Mathilde Beurrier
- Laboratoire de Pharmacologie-Toxicologie, Pharmacovigilance & Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance, Centre Hospitalier Régional et Universitaire de Nancy Brabois, Bâtiment de Biologie Médicale et de Biopathologie, Vandœuvre-Lès-Nancy, France
| | - Pierre Gillet
- Laboratoire de Pharmacologie-Toxicologie, Pharmacovigilance & Centre d'évaluation et d'information sur la Pharmacodépendance-Addictovigilance, Centre Hospitalier Régional et Universitaire de Nancy Brabois, Bâtiment de Biologie Médicale et de Biopathologie, Vandœuvre-Lès-Nancy, France
- Université de Lorraine, Centre National de la Recherche Scientifique, Ingénierie Moléculaire et Physiopathologie Articulaire, Nancy, France
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48
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McMaster C, Liew DFL, Lester S, Rischin A, Black RJ, Chand V, Fletcher A, Lassere MN, March L, Robinson PC, Buchbinder R, Hill CL. COVID-19 vaccine hesitancy in inflammatory arthritis patients: serial surveys from a large longitudinal national Australian cohort. Rheumatology (Oxford) 2023; 62:1460-1466. [PMID: 36069664 PMCID: PMC9494403 DOI: 10.1093/rheumatology/keac503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine COVID-19 vaccine hesitancy rates in inflammatory arthritis patients and identify factors associated with changing vaccine hesitancy over time. METHODS This investigation was a prospective cohort study of inflammatory arthritis patients from community and public hospital outpatient rheumatology clinics enrolled in the Australian Rheumatology Association Database (ARAD). Two surveys were conducted, one immediately prior to (pre-pandemic) and another approximately 1 year after the start of the pandemic (follow-up). Coronavirus disease 2019 (COVID-19) vaccine hesitancy was measured at follow-up, and general vaccine hesitancy was inferred pre-pandemic; these were used to identify factors associated with fixed and changing vaccine beliefs, including sources of information and broader beliefs about medication. RESULTS Of the 594 participants who completed both surveys, 74 (12%) were COVID-19 vaccine hesitant. This was associated with pre-pandemic beliefs about medications being harmful (P < 0.001) and overused (P = 0.002), with stronger beliefs resulting in vaccine hesitancy persistent over two time points (P = 0.008, P = 0.005). For those not vaccine hesitant pre-pandemic, the development of COVID-19 vaccine hesitancy was associated with a lower likelihood of seeking out vaccine information from health-care professionals (P < 0.001). COVID-19 vaccine hesitancy was not associated with new influenza vaccine hesitancy (P = 0.138). CONCLUSION In this study of vaccine beliefs before and during the COVID-19 pandemic, factors associated with COVID-19 vaccine hesitancy in inflammatory arthritis patients varied, depending on vaccine attitudes immediately prior to the start of the pandemic. Fixed beliefs reflected broader views about medications, while fluid beliefs were highly influenced by whether they sought out information from health-care professionals, including rheumatologists.
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Affiliation(s)
- Christopher McMaster
- Department of Rheumatology, Austin Health, Heidelberg, VIC, 3084
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, 3084
- The Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, 3052
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, VIC, 3084
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, 3084
- Department of Medicine, University of Melbourne, Parkville, VIC, 3052
| | - Susan Lester
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
| | - Adam Rischin
- Department of Rheumatology, The Alfred Hospital, Melbourne, VIC, 3004
| | - Rachel J Black
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
| | - Vibhasha Chand
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Ashley Fletcher
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Marissa N Lassere
- School of Population Health, UNSW Medicine, Sydney, New South Wales, Australia
- Department of Rheumatology, St George Hospital, Sydney, New South Wales, Australia
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, Australia
- Royal Brisbane & Women’s Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
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Giannopoulou N, Gupta L, Andreoli L, Lini D, Nikiphorou E, Aggarwal R, Agarwal V, Parodis I. COVID-19 vaccine safety during pregnancy in women with systemic lupus erythematosus. Autoimmun Rev 2023; 22:103292. [PMID: 36740090 PMCID: PMC9896878 DOI: 10.1016/j.autrev.2023.103292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
COVID-19 vaccination has been shown to be safe in patients with systemic lupus erythematosus (SLE), but data on vaccine-associated adverse events (AEs) during the antenatal and lactation period are scarce or lacking. We investigated COVID-19 vaccination-related AEs in pregnant SLE patients from the COVAD study, a global esurvey involving 157 collaborators from 106 countries. A total of 9201 complete responses were extracted. Among 6787 (73.8%) women, we identified 70 (1.1%) who were exposed to at least one COVID-19 vaccine dose during pregnancy, 11 with SLE. Delayed onset (>7 days) vaccine-related AEs were triangulated with disease activity, treatment changes due to flare after vaccination, and COVID-19 infections in vaccinated pregnant women. Health-related quality of life and physical function was recorded using PROMIS. Age of patients ranged from 28 to 39 years; 5/11 women were of Asian origin. None of these patients reported major vaccine AEs or change in the status of their autoimmune disease. Although minor AEs were common, they did not impair daily functioning, and the symptoms resolved after a median of 3 (IQR: 2.5-5.0) days. All patients reported good to excellent health status. No adverse pregnancy outcomes were reported. Importantly, none of the patients reported thrombotic events post-vaccination, which provides reassurance in a patient population with a high risk for cardiovascular comorbidity and thrombosis, especially in the presence of antiphospholipid antibodies or the antiphospholipid syndrome, a considerable portion of SLE patients. Our findings provide reassurance and can contribute to informed decisions regarding vaccination in patients with SLE and high-risk pregnancies due to their background autoimmune disease. The risk/benefit ratio of COVID-19 vaccination appears favourable, with vaccines both providing passive immunisation to the fetus and active immunisation to the mother with no signals of exacerbation of the mother's autoimmune disease.
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Affiliation(s)
- Nefeli Giannopoulou
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; General Hospital of Paphos, University of Nicosia, Nicosia, Cyprus
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniele Lini
- Rheumatology and Clinical Immunology Unit, Azienda Socio-Sanitaria Territoriale Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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50
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Tung KK, Chen ST, Lee CH, Tung CF, Wei JCC. Calprotectin in spondyloarthritis and gut inflammation, is it clinically meaningful? Int J Rheum Dis 2023; 26:609-612. [PMID: 37002903 DOI: 10.1111/1756-185x.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/18/2023] [Accepted: 02/06/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Tien Chen
- Department of Gastroenterology and Hepatology, Chia-Yi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
- Post Baccalaureate Medicine, School of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan
| | - Chun-Fang Tung
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming Chao-Tung University, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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