BackgroundPatients with autoimmune systemic diseases (ASDs) can be counted among frail populations as regards the predisposition to COVID-19 due to the frequent visceral organ involvement and comorbidities, as well as the ongoing immunomodulating treatments.ObjectivesOur long-term multicenter telephone survey prospectively investigated the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients during the first 3 pandemic waves.MethodsA large series of 3,918 ASD patients (815 M, 3103 F; mean age 59±12SD years) was consecutively recruited at the 36 referral centers of COVID-19 & ASD Italian Study Group. In particular, ASD series encompassed the following conditions: rheumatoid arthritis (n: 981), psoriatic arthritis (n: 471), ankylosing spondylitis (n: 159), systemic sclerosis (n: 1,738), systemic lupus (172), systemic vasculitis (n: 219), and a miscellany of other ASDs (n: 178). The development of COVID-19 was recorded by means of telephone survey using standardized symptom-assessment questionnaire (1).ResultsA significantly increased prevalence of COVID-19 (8.37% vs 6.49%; p<0.0001) was observed in our ASD patients, while the cumulative death rate revealed statistically comparable to the Italian general population (3.65% vs 2.95%; p: ns). In particular, among the 328 ASD patients complicated by COVID-19, 57 (17%) needed hospitalization, while mild-moderate manifestations were observed in the large majority of individuals (83%). In addition, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular manifestations.Interestingly, a significantly higher COVID-19-related death rate was observed in systemic sclerosis patients compared to the Italian general population (6.29% vs 2.95%; p=0.018). Other adverse prognostic factors to develop COVID-19 were the patients’ older age, male gender, pre-existing ASD-related interstitial lung involvement, and chronic steroid treatment. Conversely, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs 46.99%; p=0.000), as well as the chronic administration of low dose aspirin in a subgroup of SSc patients (with 5.57% vs without 27.84%; p=0.000).ConclusionThe cumulative impact of COVID-19 on ASD patients after the first 3 pandemic waves revealed less severe than that observed during the first phase of pandemic (1), especially with regards to the death rate that was comparable to the Italian general population in spite of the increased prevalence of complicating COVID-19 in the same ASD series.Ongoing long-term treatments, mainly csDMARDs, might usefully contribute to generally positive outcomes of in this frail patients’ population.Of note, a significantly increased COVID-19-related mortality was recorded in only SSc patients’ subgroup, possibly favored by pre-existing lung fibrosis. Among different ASD, SSc deserves special attention, since it shares the main pathological alterations with COVID-19, namely the interstitial lung involvement and the endothelial injury responsible for diffuse microangiopathy.Besides SSc, the patients’ subgroups characterized by older age, chronic steroid treatment, pre-existing interstitial lung disease, and/or impaired COVID-19 vaccine response (1-3), may deserve well-designed prevention and management strategies.References[1]Ferri C, et al. Ann Rheum Dis. 2020 Oct 14 doi: 10.1136/annrheumdis-2020-219113.[2]Ferri C et al. J Autoimmun. 2021 Dec;125:102744. doi: 10.1016/j.jaut.2021.102744.[3]Visentini M et al. Ann Rheum Dis. 2021 Nov 24. doi: 10.1136/annrheumdis-2021-221248Disclosure of InterestsNone declared
BackgroundCryoglobulinemic Vasculitis (CV) is a rare autoimmune systemic disorder with multiple organ involvement. During the current COVID-19 pandemic, the patients with CV can accounted among frail populations because of the presence of multiple organ involvement, chronic steroid treatment, and more frequent old age.ObjectivesThe present study aimed to investigate the prevalence and outcome of COVID-19, as well the safety and immunogenicity of COVID-19 vaccines in a wide CV cohort by a multicenter survey.MethodsPatients with CV were consecutively recruited at 11 Italian referral centers. CV diagnosis, clinico-serological parameters, COVID-19 tests, and vaccination immunogenicity were carried out according to current methods.ResultsFour-hundred-thirty unselected CV patients (130 M; mean age 70±10.96 years) were recruited from February 2020 to October 2021. COVID-19 prevalence was significantly higher in CV patients compared to the Italian general population (11.9% vs 8.0%, p<0.005); furthermore, we observed a higher mortality in CV subjects with COVID-19 compared to those without (5.9% vs 0.5%, p<0.01). An older age (≥60 years) correlated with a worse COVID-19 outcome. Vaccine was administered in 87% of patients, and 50% received a boostering dose. Disease flares/worsening following the vaccination were significantly less frequent than those associated to COVID-19 (5% vs 14%, p=0.0012). CV patients showed an impaired vaccination immunogenicity compared to controls (p<0.05), as well an increased no-response rate after the booster.ConclusionCV patients have a higher risk to develop COVID-19, as well of more severe disease manifestations. Vaccines had a good safety profile in CV patients and of note, the vaccine-related side effects/disease flares were significantly lower compared to those COVID-19-related. However, a quarter of vaccinated individuals do not show detectable seroconversion; this is a major challenge for clinicians. Overall, a close monitoring of these frail patients during the ongoing pandemic is particularly advisable.References[1]Ferri C, et al. Ann Rheum Dis. 2020 Oct 14 doi: 10.1136/ annrheumdis-2020-219113.[2]Visentini M et al. Ann Rheum Dis. 2021 Nov 24. doi: 10.1136/ annrheumdis-2021-221248[3]Ferri C et al. J Autoimmun. 2022 Jul;131:102866. doi: 10.1016/jAcknowledgements:NIL.Disclosure of InterestsNone Declared.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.