A deep look into the storm: Israeli multi-center experience of coronavirus disease 2019 (COVID-19) in patients with autoimmune inflammatory rheumatic diseases before and after vaccinations

Abstract

ObjectiveWe aimed to characterize the course of COVID-19 in autoimmune inflammatory rheumatic disease (AIIRD) patients in Israel, taking into consideration several remarkable aspects, including the outcomes of the different outbreaks, the effect of vaccination campaigns, and AIIRD activity post-recovery.MethodsWe established a national registry of AIIRD patients diagnosed with COVID-19, including demographic data, AIIRD diagnosis, duration and systemic involvement, comorbidities, date of COVID-19 diagnosis, clinical course, and dates of vaccinations. COVID-19 was diagnosed by a positive SARS-CoV-2 polymerase chain reaction.ResultsIsrael experienced 4 outbreaks of COVID-19 until 30.11.2021. The first three outbreaks (1.3.2020 – 30.4.2021) comprised 298 AIIRD patients. 64.9% had a mild disease and 24.2% had a severe course; 161 (53.3%) patients were hospitalized, 27 (8.9%) died. The 4th outbreak (delta variant), starting 6 months after the beginning of the vaccination campaign comprised 110 patients. Despite similar demographic and clinical characteristics, a smaller proportion of AIIRD patients had negative outcomes as compared to the first 3 outbreaks, with regards to severity (16 patients,14.5%), hospitalization (29 patients, 26.4%) and death (7 patients, 6.4%). COVID-19 did not seem to influence the AIIRD activity 1-3 months post-recovery.ConclusionsCOVID-19 is more severe and has an increased mortality in active AIIRD patients with systemic involvement, older age and comorbidities. Vaccination with 3 doses of the mRNA vaccine against SARS-CoV-2 protected from severe COVID-19, hospitalization and death during the 4th outbreak. The pattern of spread of COVID-19 in AIIRD patients was similar to the general population.

The outcome of COVID‐19 in patients with autoimmune rheumatic diseases: Comparable to the general population or worse?

“…The type of AIRD, disease activity, and organ involvements are also important while analyzing the impact of AIRDs on the COVID‐19 course 1,2 . In addition, classical comorbidities such as hypertension, obesity, and diabetes mellitus are generally more frequent among AIRD patients than the general population, and these comorbidities are associated with worse COVID‐19 outcomes 3,4 . On the other hand, most AIRD patients are on chronic immunosuppressive therapies, which may limit the hyperinflammation before the cytokine storm commences.…”

“…Regarding the treatment of AIRDs, glucocorticoids at a dose of ≥10 mg/d (prednisone equivalent), csDMARDs such as sulfasalazine, immunosuppressant drugs such as mycophenolate mofetil and tacrolimus, B cell depleting therapies such as rituximab and belimumab, and Janus kinase (JAK) inhibitors were the main drugs associated with worse COVID‐19 outcomes 3,4,6,26 . On the other hand, several studies suggested that anti‐tumor necrosis factor use was associated with a less severe COVID‐19 outcome 5,26–29 .…”

“…Vaccination against COVID‐19 has substantially changed the prevalence of severe infection both in the general population and AIRD patients. Most recently, Kharouf et al 3 have analyzed the COVID‐19 outcomes in AIRD patients considering the effect of different outbreaks and the vaccination campaigns. They showed that older age, AIRD‐related lung involvement, diabetes mellitus, and treatment with glucocorticoids, mycophenolate mofetil, and JAK inhibitors were associated with a higher hospitalization rate in AIRD patients.…”

Risk factors for severe COVID-19 outcomes: a study of immune-mediated inflammatory diseases, immunomodulatory medications, and comorbidities in a large US healthcare system

“…Given established and potential COVID-19 risk factors, individuals with IMIDs are of particular interest and complexity for risk analysis. 2,3,4,5 This population has a higher rate of severe COVID-19 outcomes, but we need to understand why. Potential reasons include immune dysregulation, the use of immunomodulatory drugs (IMMs), and/or associated chronic comorbidities.…”