COVID‐19 Vaccination In Autoimmune Diseases (COVAD) Study: Vaccine Safety In Idiopathic Inflammatory Myopathies

Introduction/Aims

In this study we investigated COVID‐19 vaccination–related adverse events (ADEs) 7 days postvaccination in patients with idiopathic inflammatory myopathies (IIMs) and other systemic autoimmune and inflammatory disorders (SAIDs).

Methods

Seven‐day vaccine ADEs were collected in an international patient self‐reported e‐survey. Descriptive statistics were obtained and multivariable regression was performed.

Results

Ten thousand nine hundred respondents were analyzed (1227 IIM cases, 4640 SAID cases, and 5033 healthy controls [HCs]; median age, 42 [interquartile range, 30‐455] years; 74% female; 45% Caucasian; 69% completely vaccinated). Major ADEs were reported by 76.3% of the IIM patients and 4.6% reported major ADEs. Patients with active IIMs reported more frequent major (odds ratio [OR], 2.7; interquartile range [IQR], 1.04‐7.3) and minor (OR, 1.5; IQR, 1.1‐2.2) ADEs than patients with inactive IIMs. Rashes were more frequent in IIMs (OR, 2.3; IQR, 1.2‐4.2) than HCs. ADEs were not impacted by steroid dose, although hydroxychloroquine and intravenous/subcutaneous immunoglobulins were associated with a higher risk of minor ADEs (OR, 1.9; IQR, 1.1‐3.3; and OR, 2.2; IQR, 1.1‐4.3, respectively). Overall, ADEs were less frequent in inclusion‐body myositis (IBM) and BNT162b2 (Pfizer) vaccine recipients.

Discussion

Seven‐day postvaccination ADEs were comparable in patients with IIMs, SAIDs, and HCs, except for a higher risk of rash in IIMs. Patients with dermatomyositis with active disease may be at higher risk, and IBM patients may be at lower risk of specific ADEs. Overall, the benefit of preventing severe COVID‐19 through vaccination likely outweighs the risk of vaccine‐related ADEs. Our results may inform future guidelines regarding COVID‐19 vaccination in patients with SAIDs, specifically in those with IIMs. Studies to evaluate long‐term outcomes and disease flares are needed to shed more light on developing future COVID‐19 vaccination guidelines.

MicroRNA-132, miR-146a, miR-155 as potential biomarkers of Methotrexate response in patients with Rheumatoid arthritis

Introduction

MiRNAs regulate signaling pathways of inflammation and thus can serve as biomarkers. Patients with Rheumatoid arthritis (RA) have high expression of miR-155, miR-146a and miR-132 in their peripheral blood cells. As one third of patients do not respond to methotrexate(MTX), the first line therapy in RA, we studied if levels of these miRNAs can predict response to MTX.

Methods

Patients with RA (ACR 2010 criteria), DMARD naïve with active disease (DAS 28 >3.2) were enrolled. Blood sample was collected. All patients were treated with MTX by gradually increasing dose to a maximum of 25mg/week or the maximal tolerated dose. No corticosteroids were given. At 4 months disease activity was measured by DAS 28 and EULAR response was assessed. miR-132, miR-146a and miR-155 were measured using real time qPCR in the whole blood RNA. Let7a was used as a housekeeping gene.

Results

80 patients (83.8% females; mean age 41.05+12.19 years); mean duration of disease 2.23+1.95years; mean DAS28 4.56+ 0.71) were enrolled. Among 80 patients 59 were classified as good responders while 14 were moderate- responders and 7 were non-responders at 4 months. The baseline miRNA levels did not correlate with the baseline DAS28 score or any other clinical parameters of RA patients. All the three miRNA’s were lower in responders as compared to non-responders but it was significant only for miR-155 (p=0.016) with mean value −7.531±0.833 for responders (n=73) and −6.476±1.069 for non-responders (n=7). ROC curve analysis showed that miR-155 with cutoff value of −7.3(dtCt) is predictor of non-response to MTX treatment with a sensitivity of 67.1% and a specificity of 71.4% (AUC:0.777, p=0.016).

Conclusion

MicroRNA-155 may serve as a good biomarker of response to MTX.

Myeloid-related Protein 8/14 Levels in Rheumatoid Arthritis: Marker of Disease Activity and Response to Methotrexate

Objective.

Myeloid-related proteins (MRP) 8/14 belong to a family of calcium-binding proteins produced by myeloid cells. Baseline serum levels of MRP8/14 have been shown to predict response to biologicals in rheumatoid arthritis (RA). Because methotrexate (MTX) is the first-line therapy in RA, we studied whether MRP8/14 levels can predict response to MTX.

Methods.

Patients with active RA disease who were naive to disease-modifying antirheumatic drugs were enrolled. All patients were treated with MTX only, to a maximum of 25 mg/week or the maximal tolerated dose. At 4 months, the European League Against Rheumatism response was assessed. All patients who needed rescue therapy after 2 months or who did not respond at 4 months were classified as nonresponders.

Results.

Ninety patients were enrolled, of whom 3 discontinued MTX within 4–6 weeks, so 87 patients were analyzed [74 women, median (interquartile range; IQR) for the Disease Activity Score at 28 joints (DAS28) was 4.43 (4.1–5.1)]. The median (IQR) serum MRP8/14 level at baseline was 19.95 µg/ml (11.49–39.06). The serum MRP8/14 had good correlation with DAS28-C-reactive protein (CRP; r = 0.35, p = 0.001). The MRP8/14 levels fell significantly after 4 months of treatment (10.28 µg/ml, 5.95–16.05, p < 0.001). Among 87 patients, 69 were responders. The median (IQR) baseline level of MRP8/14 was higher among responders compared with nonresponders: 23.99 µg/ml (15.39–42.75) versus 9.58 µg/ml (6.11–24.93, p = 0.00250). The levels declined in the responders, from 23.99 µg/ml (15.39–42.75) to 10.41 µg/ml (5.83–15.61, p < 0.001), but not in the nonresponders, from 9.58 µg/ml (6.11–24.93) to 9.19 µg/ml (7.74–21.96, p = 0.687). Receiver-operation characteristic analysis showed that MRP8/14 was a better predictor of response than CRP and erythrocyte sedimentation rate, especially with early disease onset (< 1-yr duration).

Conclusion.

MRP8/14 is a good marker of disease activity in RA, and higher levels predict response to MTX.