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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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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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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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4
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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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Deibel E, Carreira PE, Vonk M, Del Papa N, Bečvář R, Guillén-Del-Castillo A, Campochiaro C, Poormoghim H, Liem S, Lazzaroni MG, Giollo A, Mekinian A, de Vries-Bouwstra J, De Santis M, Balbir-Gurman A, Mihai C, De Luca G, Moiseev S, Zanatta E, Foti R, Rednic S, Denton C, Cutolo M, Belloli L, Airo P, Garzanova L, Moroncini G, İnanç M, Panopoulos S, Tandaipan JL, Chatelus E, Rosato E, Kuwana M, Yavuz S, Alegre-Sancho JJ, Smith V, Szűcs G, Henes J, Rodríguez-Pintó I, Atzeni F, Spierings J, Truchetet ME, Milchert M, Brito de Araujo D, Riemekasten G, Bernardino V, Martin T, Del Galdo F, Vacca A, Mendoza F, Midtvedt Ø, Murdaca G, Santiago T, Codullo V, Cacciapaglia F, Walker U, Brunborg C, Tirelli F, Allanore Y, Furst DE, Matucci M, Gabrielli A, Distler O, Hoffmann-Vold AM. Does the Impact of COVID-19 on Patients With Systemic Sclerosis Change Over Time? Arthritis Care Res (Hoboken) 2024; 76:88-97. [PMID: 37667424 DOI: 10.1002/acr.25226] [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: 03/31/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The outcome of patients with COVID-19 improved over the pandemic, including patients with systemic rheumatic diseases. However, data on patients with systemic sclerosis (SSc) are lacking. This study aimed to assess the outcome of patients with both SSc and COVID-19 over several waves. METHODS Patients with both SSc and COVID-19 who were registered in the European Scleroderma Trials and Research group (EUSTAR) were collected between April 2020 and April 2021. Patients were assigned to waves 1, 2, or 3 depending on the date of their COVID-19 diagnosis. Primary endpoints were death, intensive care unit stay, or ventilatory support (severe outcome). Subgroup analyses of patients who were hospitalized or died were conducted. General and SSc-specific characteristics and treatment were compared over the waves. Descriptive statistics and multivariate logistic regression were applied. RESULTS A total of 333 patients were included; 57 patients (17%) had a severe outcome, and 30 patients (9%) died. Compared to wave 1, significantly fewer patients with SSc suffered from severe COVID-19 in waves 2 and 3 (28.2% vs 9.8% and 12.7%; P < 0.001), fewer patients required hospitalization (46.7% vs 19.6% and 25.5%; P < 0.001) or ventilatory support (24.0% vs 8.7% and 10.9%; P = 0.001), and fewer patients died (15.7% vs 5.0% and 7.5%; P = 0.011). Patients were significantly younger, more often men, had less frequent arterial hypertension, and less SSc cardiac involvement over waves 1 to 3. Patients received significantly less medium to high doses of corticosteroids as they did SSc treatment. CONCLUSION The outcome of patients with both SSc and COVID-19 improved significantly over time because of intrinsic and extrinsic factors.
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Affiliation(s)
- Elisabeth Deibel
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Madelon Vonk
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Radim Bečvář
- 1st Medical School, Charles University, Praha, Czech Republic
| | | | | | | | - Sophie Liem
- Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | - Maria De Santis
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy, and Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carina Mihai
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Sergey Moiseev
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Rosario Foti
- A.O.U. Policlinico S. Marco Catania, Catania, Italy
| | - Simona Rednic
- University of Medicine & Pharmacy "Iuliu Hatieganu" Cluj, Cluj-Napoca, Romania
| | | | | | - Laura Belloli
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paolo Airo
- ASST Spedali Civili of Brescia, University of Brescia, Italy
| | - Liudmila Garzanova
- VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Gianluca Moroncini
- Università Politecnica delle Marche, Polo Didattico, University of Ancona, Ancona, Italy
| | | | | | | | - Emmanuel Chatelus
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares Est/Sud-Ouest (RESO), Strasbourg, France
| | | | | | | | | | - Vanessa Smith
- Ghent University, Ghent University Hospital, and VIB Inflammation Research Center (IRC), Ghent, Belgium
| | | | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases (INDIRA), University Hospital Tuebingen, Tuebingen, Germany
| | | | | | | | | | | | | | - Gabriela Riemekasten
- University Clinic Schleswig Holstein Lübeck, University of Lübeck, Lübeck, Germany
| | - Vera Bernardino
- Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Thierry Martin
- Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO), Nouvel Hôpital Civil, Strasbourg, France
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, Leeds, UK
| | | | | | | | - Giuseppe Murdaca
- University of Genova and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tânia Santiago
- Centro Hospital e Universitário de Coimbra, University of Coimbra, Portugal
| | | | | | | | | | - Francesca Tirelli
- University Hospital Zurich, University of Zurich, Zurich, Switzerland, and University of Padova, Padova, Italy
| | | | | | - Marco Matucci
- University of Florence, Florence, Italy and IRCCS San Raffaele Hospital, Milan, Italy
| | - Armando Gabrielli
- Università Politecnica delle Marche, Polo Didattico, University of Ancona, Ancona, Italy
| | - Oliver Distler
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna-Maria Hoffmann-Vold
- University Hospital Zurich, University of Zurich, Zurich, Switzerland and Oslo University Hospital, Oslo, Norway
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6
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Kowalski EN, Wang X, Patel NJ, Kawano Y, Cook CE, Vanni KMM, Qian G, Bade KJ, Srivatsan S, Williams ZK, Wallace ZS, Sparks JA. Risk factors and outcomes for repeat COVID-19 infection among patients with systemic autoimmune rheumatic diseases: A case-control study. Semin Arthritis Rheum 2023; 63:152286. [PMID: 37913612 PMCID: PMC10842150 DOI: 10.1016/j.semarthrit.2023.152286] [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: 08/02/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To investigate risk factors and outcomes of repeat COVID-19 infections among patients with systemic autoimmune rheumatic diseases (SARDs). METHODS We performed a case-control study investigating repeat COVID-19 infection within the Mass General Brigham Health Care System. We systematically identified all SARD patients with confirmed COVID-19 (15/Mar/2020 to 17/Oct/2022). Cases had confirmed repeat COVID-19 infections >60 days apart (index date: repeat COVID-19 date). Controls were matched to cases (up to 3:1) by calendar date of first infection and duration between first COVID-19 infection and index dates. We collected demographics, lifestyle, comorbidities, SARD features, and COVID-19 characteristics at initial infection and index date by medical record review. We used conditional logistic regression to identify associations with repeat COVID-19 infection, adjusting for potential confounders. We described the severity of repeat COVID-19 infection among cases. RESULTS Among 2203 SARD patients with COVID-19, we identified 76 cases with repeat COVID-19 infection (80.3 % female) and matched to 207 matched controls (77.8 % female) with no repeat infection. At first infection, cases were younger (mean 49.5 vs. 60.3 years, p < 0.0001), less likely to have hypertension (32.9 % vs. 45.9 %, p = 0.050), and less likely to have been hospitalized for COVID-19 (13.2 % vs. 24.6 %, p = 0.037) than controls. At index date, cases were more likely than controls to be rituximab users (18.4 % vs. 6.3 %, p = 0.0021). In the multivariable model, younger age (OR 0.67 per 10 years, 95 %CI 0.54-0.82), rituximab use vs. non-use (OR 3.38, 95 %CI 1.26-9.08), and methotrexate use vs. non-use (OR 2.24, 95 %CI 1.08-4.61) were each associated with repeat COVID-19 infection. Among those with repeat COVID-19 infection, 5/76 (6.6 %) were hospitalized and there were no deaths. CONCLUSION Younger age, rituximab, and methotrexate were each associated with repeat COVID-19 infection risk among patients with SARDs. Reassuringly, there were no deaths, and the hospitalization rate was low among those with repeat COVID-19 infection.
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Affiliation(s)
- Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Xiaosong Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Yumeko Kawano
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, USA
| | - Claire E Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Katarina J Bade
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Shruthi Srivatsan
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Zachary K Williams
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, USA.
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7
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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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8
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Batu ED, Demirkan FG, Sag E, Lamot L, Faleye A, Marrani E, Ziv A, Ardalan K, Gmuca S, Swart JF, Uziel Y. The impact of the COVID-19 pandemic on pediatric rheumatology practice: an international, cross-sectional survey study. Semin Arthritis Rheum 2023; 63:152289. [PMID: 37918050 PMCID: PMC11089463 DOI: 10.1016/j.semarthrit.2023.152289] [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: 07/26/2023] [Revised: 09/22/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has affected patient care in general. We aimed to analyze the impact of the pandemic on pediatric rheumatology practice. METHODS An online survey including 22 questions was created by the representatives of the Emerging RheumatoloGists and rEsearchers (EMERGE) group of the Pediatric Rheumatology European Society (PReS) on SurveyMonkey. The descriptive analysis of the responses was performed on SurveyMonkey. RESULTS Overall, 469 pediatric rheumatologists (F/M: 2.9) from 70 countries completed the survey. The practice of drug prescription is not affected by the pandemic, according to 65.3 % of the respondents, while 24.3 % and 16.5 % are prescribing biologic drugs and corticosteroids less often, respectively. Over 40 % of the respondents have seen an increased number of patients with vasculitis or chilblains during the pandemic. One-third of the respondents stated no adjustments in their clinical practice after 2.5 years of COVID-19 pandemic. The rest indicated implementing various changes, with an emphasis on incorporating telemedicine. Telemedicine constitutes ≥10 % of the clinical practice for one-third of the participants. Nonetheless, 35.5 % agree that there are still delays in patient care due to the pandemic. However, most (∼90 %) think our practice is returning to the pre-pandemic routine. CONCLUSION The findings of our study indicate a significant alteration in pediatric rheumatology practice due to the pandemic. This includes increased caution when prescribing anti-rheumatic drugs, a transition towards telemedicine utilization, delays in routine care, and a rise in COVID-19-related inflammatory conditions. It is imperative to address these aspects in order to improve patient care in pediatric rheumatology.
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Affiliation(s)
- Ezgi D Batu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Ankara, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Erdal Sag
- Ankara Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Lovro Lamot
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia; Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ayodele Faleye
- Paediatric Rheumatology Unit, Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Edoardo Marrani
- Pediatric Rheumatology Unit, AOU Meyer IRCCS, Firenze, Italy
| | - Amit Ziv
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Kaveh Ardalan
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sabrina Gmuca
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, United States of America
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, UMC Utrecht, Netherlands
| | - Yosef Uziel
- Tel Aviv University School of Medicine, Israel and Pediatric Rheumatology Unit, Meir Medical Center, Department of Pediatrics, Kfar Saba, Tel Aviv, Israel
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9
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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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10
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Svensson ALL, Emborg HD, Bartels LE, Ellingsen T, Adelsten T, Cordtz R, Dreyer L, Obel N. Outcomes following SARS-CoV-2 infection in individuals with and without inflammatory rheumatic diseases: a Danish nationwide cohort study. Ann Rheum Dis 2023; 82:1359-1367. [PMID: 37414519 DOI: 10.1136/ard-2023-223974] [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: 02/15/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE In a setting with an extensive SARS-CoV-2 test strategy and availability of effective vaccines, we aimed to investigate if patients with inflammatory rheumatic diseases (IRD) face greater risk of contracting SARS-CoV-2 and have a worse prognosis of increased risk of hospitalisation, assisted ventilation and death compared with the general population. METHODS This was a nationwide, population-based register study that compared outcomes of SARS-CoV-2 infection in Danish patients with IRD (n=66 840) with matched population controls (n=668 400). The study period was from March 2020 to January 2023. Cox regression analyses were used to calculate incidence rate ratios (IRRs) for SARS-CoV-2-related outcomes. RESULTS We observed a difference in time to first and second positive SARS-CoV-2 test in patients with IRD compared with the general population (IRR 1.06, 95% CI 1.05 to 1.07) and (IRR 1.21, 95% CI 1.15 to 1.27). The risks of hospital contact with COVID-19 and severe COVID-19 were increased in patients with IRD compared with population controls (IRR 2.11, 95% CI 1.99 to 2.23) and (IRR 2.18, 95% CI 1.94 to 2.45). The risks of assisted ventilation (IRR 2.33, 95% CI 1.89 to 2.87) and COVID-19 leading to death were increased (IRR 1.98, 95% CI 1.69 to 2.33). Patients with IRD had more comorbidities compared with the general population. A third SARS-CoV-2 vaccination was associated with a reduced need for hospitalisation with COVID-19 and reduced the risk of death. CONCLUSION Patients with IRD have a risk of SARS-CoV-2, which nearly corresponds to the general population but had a substantial increased risk of hospitalisation with COVID-19, severe COVID-19, requiring assisted ventilation and COVID-19 leading to death, especially in patients with comorbidities.
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Affiliation(s)
- Annemarie Lyng Lyng Svensson
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Rigshospitalet HovedOrtoCentret, Kobenhavn, Denmark
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Kobenhavn, Denmark
| | | | | | - Thomas Adelsten
- Department of Rheumatology, Sjællands Universitetshospital Køge, Koge, Denmark
| | - René Cordtz
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Rheumatology, Gentofte Hospital, Hellerup, Denmark
| | - Lene Dreyer
- Department of Rheumatology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Obel
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Kobenhavn, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Kobenhavn, Denmark
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11
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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: 0] [Impact Index Per Article: 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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12
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Ramirez GA, Gerosa M, Bellocchi C, Arroyo-Sánchez D, Asperti C, Argolini LM, Gallina G, Cornalba M, Scotti I, Suardi I, Moroni L, Beretta L, Bozzolo EP, Caporali R, Dagna L. Efficacy and Safety of Anti-SARS-CoV-2 Antiviral Agents and Monoclonal Antibodies in Patients with SLE: A Case-Control Study. Biomolecules 2023; 13:1273. [PMID: 37759674 PMCID: PMC10527378 DOI: 10.3390/biom13091273] [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: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (COVID-19) has spread pandemically with high rates of morbidity and mortality. COVID-19 has also posed unprecedented challenges in terms of rapid development of pharmacological countermeasures to prevent or contrast SARS-CoV-2 pathogenicity. Anti-SARS-CoV-2 antiviral agents and monoclonal antibodies have been specifically designed to attenuate COVID-19 morbidity and prevent mortality in vulnerable subjects, such as patients with immune-mediated diseases, but evidence for the safe and effective use of these drugs in this latter population group is scarce. Therefore, we designed a retrospective, multicentre, observational, case-control study to analyse the impact of these treatments in COVID-19 patients with systemic lupus erythematosus (SLE), a paradigmatic, multi-organ autoimmune disease. We identified 21 subjects treated with antivirals and/or monoclonal antibodies who were matched with 42 untreated patients by age, sex, SLE extension and duration. Treated patients had higher baseline SLE disease activity index 2000 scores [SLEDAI-2K median (interquartile range) = 4 (1-5) vs. 0 (0-2); p = 0.009], higher prednisone doses [5 (0-10) mg vs. 0 (0-3) mg; p = 0.002], and more severe COVID-19 symptoms by a five-point World Health Organisation-endorsed analogue scale [1 (0-1) vs. 0 (0-1); p < 0.010] compared to untreated patients. There was no difference between groups in terms of COVID-19 outcomes and sequelae, nor in terms of post-COVID-19 SLE exacerbations. Three subjects reported mild adverse events (two with monoclonal antibodies, one with nirmatrelvir/ritonavir). These data suggest that anti-SARS-CoV-2 antivirals and monoclonal antibodies might be safely and effectively used in patients with SLE, especially with active disease and more severe COVID-19 symptoms at presentation.
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Affiliation(s)
- Giuseppe A. Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (D.A.-S.); (C.A.); (G.G.); (L.M.); (E.P.B.); (L.D.)
- Faculty of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy
| | - Maria Gerosa
- Department of Clinical Science of Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (M.G.); (L.M.A.); (M.C.); (I.S.); (I.S.); (R.C.)
- Unit of Rheumatology, ASST Gaetano Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy
| | - Chiara Bellocchi
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza 35, 20122 Milan, Italy; (C.B.); (L.B.)
- Department of Clinical Science of Community Health, Section of Internal Medicine, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Daniel Arroyo-Sánchez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (D.A.-S.); (C.A.); (G.G.); (L.M.); (E.P.B.); (L.D.)
- Department of Immunology, Hospital Universitario 12 de Octubre, Av de Córdoba, 28041 Madrid, Spain
- Department of Immunology, Instituto de Investigación Biomédica, Hospital Universitario 12 de Octubre, Av de Córdoba, 28041 Madrid, Spain
| | - Chiara Asperti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (D.A.-S.); (C.A.); (G.G.); (L.M.); (E.P.B.); (L.D.)
- Faculty of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy
| | - Lorenza M. Argolini
- Department of Clinical Science of Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (M.G.); (L.M.A.); (M.C.); (I.S.); (I.S.); (R.C.)
- Unit of Rheumatology, ASST Gaetano Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy
| | - Gabriele Gallina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (D.A.-S.); (C.A.); (G.G.); (L.M.); (E.P.B.); (L.D.)
- Faculty of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy
| | - Martina Cornalba
- Department of Clinical Science of Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (M.G.); (L.M.A.); (M.C.); (I.S.); (I.S.); (R.C.)
- Unit of Rheumatology, ASST Gaetano Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy
| | - Isabella Scotti
- Department of Clinical Science of Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (M.G.); (L.M.A.); (M.C.); (I.S.); (I.S.); (R.C.)
- Unit of Rheumatology, ASST Gaetano Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy
| | - Ilaria Suardi
- Department of Clinical Science of Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (M.G.); (L.M.A.); (M.C.); (I.S.); (I.S.); (R.C.)
- Unit of Rheumatology, ASST Gaetano Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy
| | - Luca Moroni
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (D.A.-S.); (C.A.); (G.G.); (L.M.); (E.P.B.); (L.D.)
- Faculty of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza 35, 20122 Milan, Italy; (C.B.); (L.B.)
- Department of Clinical Science of Community Health, Section of Internal Medicine, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Enrica P. Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (D.A.-S.); (C.A.); (G.G.); (L.M.); (E.P.B.); (L.D.)
| | - Roberto Caporali
- Department of Clinical Science of Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (M.G.); (L.M.A.); (M.C.); (I.S.); (I.S.); (R.C.)
- Unit of Rheumatology, ASST Gaetano Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy; (D.A.-S.); (C.A.); (G.G.); (L.M.); (E.P.B.); (L.D.)
- Faculty of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy
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13
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Batu ED, Erden A. The outcome of COVID-19 in patients with autoimmune rheumatic diseases: Comparable to the general population or worse? Int J Rheum Dis 2023; 26:1435-1439. [PMID: 37527023 DOI: 10.1111/1756-185x.14766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Ezgi Deniz Batu
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Sciences, Gazi University Faculty of Medicine, Ankara, Turkey
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14
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Starkey T, Ionescu MC, Tilby M, Little M, Burke E, Fittall MW, Khan S, Liu JKH, Platt JR, Mew R, Tripathy AR, Watts I, Williams ST, Appanna N, Al-Hajji Y, Barnard M, Benny L, Burnett A, Bytyci J, Cattell EL, Cheng V, Clark JJ, Eastlake L, Gerrand K, Ghafoor Q, Grumett S, Harper-Wynne C, Kahn R, Lee AJX, Lomas O, Lydon A, Mckenzie H, Panneerselvam H, Pascoe JS, Patel G, Patel V, Potter VA, Randle A, Rigg AS, Robinson TM, Roylance R, Roques TW, Rozmanowski S, Roux RL, Shah K, Sheehan R, Sintler M, Swarup S, Taylor H, Tillett T, Tuthill M, Williams S, Ying Y, Beggs A, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe A, Fowler T, Johnson P, Lee LYW. A population-scale temporal case-control evaluation of COVID-19 disease phenotype and related outcome rates in patients with cancer in England (UKCCP). Sci Rep 2023; 13:11327. [PMID: 37491478 PMCID: PMC10368624 DOI: 10.1038/s41598-023-36990-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
Patients with cancer are at increased risk of hospitalisation and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the SARS-CoV-2 phenotype evolution in patients with cancer since 2020 has not previously been described. We therefore evaluated SARS-CoV-2 on a UK populationscale from 01/11/2020-31/08/2022, assessing case-outcome rates of hospital assessment(s), intensive care admission and mortality. We observed that the SARS-CoV-2 disease phenotype has become less severe in patients with cancer and the non-cancer population. Case-hospitalisation rates for patients with cancer dropped from 30.58% in early 2021 to 7.45% in 2022 while case-mortality rates decreased from 20.53% to 3.25%. However, the risk of hospitalisation and mortality remains 2.10x and 2.54x higher in patients with cancer, respectively. Overall, the SARS-CoV-2 disease phenotype is less severe in 2022 compared to 2020 but patients with cancer remain at higher risk than the non-cancer population. Patients with cancer must therefore be empowered to live more normal lives, to see loved ones and families, while also being safeguarded with expanded measures to reduce the risk of transmission.
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Affiliation(s)
- Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Michael Tilby
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Emma Burke
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Sam Khan
- University of Leicester, Leicester, UK
| | | | - James R Platt
- Leeds Institute of Medical Research at St James's, Leeds, UK
| | - Rosie Mew
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | | | | | | | | | - Youssra Al-Hajji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | | | | | - Jola Bytyci
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Qamar Ghafoor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Grumett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Oliver Lomas
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Anna Lydon
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Hayley Mckenzie
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Jennifer S Pascoe
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Vanessa A Potter
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Anne S Rigg
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Tom W Roques
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - René L Roux
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ketan Shah
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Remarez Sheehan
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Martin Sintler
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | | | - Mark Tuthill
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sarah Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Yuxin Ying
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrew Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Tim Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Siow Ming Lee
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mark Middleton
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrew Protheroe
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Fowler
- UK Health Security Agency, London, UK
- William Harvey Research Institute, London, UK
| | | | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
- Department of Oncology, University of Oxford, Oxford, UK.
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15
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Xiang N, Li YJ, Liu MY, Wu QQ, Zhang YX, Jin HZ, Wang Q, Li YW, Tong DL, Xue T, Jin TC, Bao W, Chen Z. Antibody responses following the surge of SARS-CoV-2 Omicron infection among patients with systemic autoimmune rheumatic diseases. Rheumatol Adv Pract 2023; 7:rkad064. [PMID: 37547578 PMCID: PMC10398008 DOI: 10.1093/rap/rkad064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives The surge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant Omicron infections has affected most Chinese residents at the end of 2022, including a number of patients with systemic autoimmune rheumatic diseases (SARDs). Methods To investigate the antibody level of the Omicron variant in SARD patients after SARS-CoV-2 Omicron infection, we tested BA.5.2 and BF.7 Omicron variant IgG antibody levels using ELISA on blood samples collected from 102 SARD patients and 19 healthy controls (HCs). The type of SARD, demographics, concurrent treatment, doses of SARS-CoV-2 vaccines and outcomes were also recorded. Results A total of 102 SARD patients (mean age: 40.3 years; 89.2% female), including 60 SLE, 32 RA and 10 other SARDs, were identified. Of these, 87 (85.3%) were infected with SARS-CoV-2. We found that the BA.5.2 and BF.7 antibody levels of infected SARD patients were lower than those of HCs (P < 0.05). Sixty-five (63.7%) patients had at least one dose of a SARS-CoV-2 vaccine. SARD patients with at least two doses of SARS-CoV-2 vaccine had a higher level of BA.5.2 and BF.7 antibodies than the unvaccinated group (P < 0.05). There was no evidence for a significant inhibitory effect of glucocorticoids (GCs) on the BA.5.2 and BF.7 Omicron variant antibody levels in SARD patients. SLE patients using biologic DMARDs had a lower BA.5.2 Omicron variant antibody level than patients using GCs and/or HCQ. Conclusion These data suggest that patients with SARDs had a lower antibody response than HCs after Omicron infection.
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Affiliation(s)
| | | | - Meng-Yao Liu
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Qi-Qin Wu
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ya-Xin Zhang
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hui-Zhi Jin
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Qian Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yu-Wei Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Da-Li Tong
- Department of Ophthalmology, The First Affiliated Hospital of USTC, School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Tian Xue
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Hefei National Research Center for Physical Sciences at the Microscale Neurodegenerative Disorder Research Center, CAS Key Laboratory of Brain Function and Disease, CAS Key Laboratory of Innate Immunity and Chronic Disease, Biomedical Sciences and Health Laboratory of Anhui Province, University of Science and Technology of China, Hefei, China
- Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China
| | - Teng-Chuan Jin
- Correspondence to: Teng-Chuan Jin and Zhu Chen, Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, No. 17 Lujiang Road, Hefei, Anhui 230001, China. E-mail: ;
| | - Wei Bao
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zhu Chen
- Correspondence to: Teng-Chuan Jin and Zhu Chen, Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, No. 17 Lujiang Road, Hefei, Anhui 230001, China. E-mail: ;
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16
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Benny L, Mehta P, Ahmed S, Paul A, Sukumaran A, Mohanan M, Vijayan A, Kaveri K, Padmaja R, Shenoy P. Correlates of breakthrough Omicron (B.1.1.529) infections in a prospective cohort of vaccinated patients with rheumatic diseases. Rheumatol Int 2023; 43:1033-1039. [PMID: 37029793 PMCID: PMC10082437 DOI: 10.1007/s00296-023-05314-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Data on the effectiveness of SARS-CoV-2 vaccines and the durability of protection against the prevalent Omicron variant are scarce, especially in patients with autoimmune rheumatic diseases (AIRDs). Hence, we prospectively studied Omicron breakthrough infections in patients with AIRDs and attempted to isolate associated risk factors. METHODS Patients with AIRDs who had completed primary vaccination with either AZD1222 or BBV152 vaccines were included and prospectively followed up from January 2022 onwards for the development of breakthrough Omicron infections. The time interval from the last event [2nd dose of vaccination (V) or past COVID-19 infection (I) whichever was later] to Omicron infection was recorded. Patients were divided based on the events and their order of occurrence into V + V, V + I, I + V, V + I + V, and V + V + I groups. The incidence of breakthrough infections and their predictors were studied with a focus on the vaccine type and hybrid (H) immunity (vaccinated individuals with a history of COVID-19 infection). RESULTS We included 907 patients with AIRDs (53.5 ± 11.7 years and a male-to-female ratio of 1:5.1), and the majority of patients had received AZD1222 (755, 83.2%). Breakthrough infections were observed in 158 of 907(17.4%) of which 97 (10.4%) were confirmed by RT-PCR. Breakthrough infections were significantly greater in the V versus the H group (15.7% and 3.5%, log-rank test, p = < 0.01). Among the hybrid group, the order of infection and vaccination had no bearing on the risk of breakthrough infections. On multivariate analysis, breakthrough infections were significantly lesser in the H versus the V group [HR: 0.2(0.1-0.4); p = 0.01]. CONCLUSION The risk of breakthrough Omicron infections in fully vaccinated patients with AIRDs was 17.4% with a significantly lower risk in patients with hybrid immunity.
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Affiliation(s)
- Libin Benny
- Centre for Arthritis and Rheumatism Excellence, Dr Shenoys Care, Nettor, Kochi, 682040, Kerala, India
| | - Pankti Mehta
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sakir Ahmed
- Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Aby Paul
- Centre for Arthritis and Rheumatism Excellence, Dr Shenoys Care, Nettor, Kochi, 682040, Kerala, India
| | - Aswathy Sukumaran
- Centre for Arthritis and Rheumatism Excellence, Dr Shenoys Care, Nettor, Kochi, 682040, Kerala, India
| | - Manju Mohanan
- Centre for Arthritis and Rheumatism Excellence, Dr Shenoys Care, Nettor, Kochi, 682040, Kerala, India
| | - Anuroopa Vijayan
- Centre for Arthritis and Rheumatism Excellence, Dr Shenoys Care, Nettor, Kochi, 682040, Kerala, India
| | - K Kaveri
- Centre for Arthritis and Rheumatism Excellence, Dr Shenoys Care, Nettor, Kochi, 682040, Kerala, India
| | - R Padmaja
- Centre for Arthritis and Rheumatism Excellence, Dr Shenoys Care, Nettor, Kochi, 682040, Kerala, India
| | - Padmanabha Shenoy
- Centre for Arthritis and Rheumatism Excellence, Dr Shenoys Care, Nettor, Kochi, 682040, Kerala, India.
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17
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Managing immunosuppression in vasculitis patients in times of COVID-19. Rheum Dis Clin North Am 2023. [PMCID: PMC10011035 DOI: 10.1016/j.rdc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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