Amyloidosis and COVID-19: experience from an amyloid program in Canada

Abstract

Severe acute respiratory syndrome coronavirus (SARS-CoV2) and associated COVID-19 infection continue to impact patients globally. Patients with underlying health conditions are at heightened risk of adverse outcomes from COVID-19; however, research involving patients with rare health conditions remains scarce. The amyloidoses are a rare grouping of protein deposition diseases. Light-chain and transthyretin amyloidosis are the most common disease forms, often present with systemic involvement of vital organs including the heart, nerves, kidneys, and GI tracts of affected individuals. The Amyloidosis Program of Calgary examined 152 ATTR patients and 103 AL patients analyzing rates of vaccination, COVID-19 testing, infection outcomes, influence referrals, and excess deaths. Results showed 15 total PCR-confirmed COVID-19 infections in the tested population of amyloid patients, with a higher frequency of infections among patient with AL compared to the ATTR cohort (26.2% vs 5.1%). Four patients (26.6%) required hospital admission for COVID-19 infection, 2 ATTR, and 2 AL patients. Of the confirmed cases, 1 (0.07%) unvaccinated ATTR patient died of a COVID-19 infection. An excess of deaths was found in both the ATTR and AL cohorts when comparing pre-pandemic years 2018 and 2019 to the pandemic years of 2020 and 2021. The finding suggests that amyloidosis patients are likely at a high risk for severe COVID-19 infection and mortality, especially those of advanced age, those on an active treatment with chemotherapy, and those with concomitant B-cell or plasma cell disorder. The impact of virtual healthcare visits and pandemic measures on the excess of deaths observed requires further research.

COVID-19 Infection and Vaccination and Its Relation to Amyloidosis: What Do We Know Currently?

“…Whilst the specific breakdown of the amyloidosis group was not reported, these patients who were admitted to hospital had a significantly raised mortality rate of 28%. Similar findings were presented by Lewis et al [ 16 ], who evaluated a cohort of 152 ATTR patients and 103 AL amyloidosis patients during the period between January 2020 and April 2022. They found that patients with amyloidosis were at high risk of severe infection and mortality from COVID-19, in particular those of older age and receiving active immunotherapy.…”

“…The combination of quarantine measures and the disruption of non-emergency healthcare services resulted in reduced access to healthcare for patients with chronic diseases, such as amyloidosis [ 20 , 21 ]. Furthermore, those with new or relapsing disease were likely to experience delays in diagnostics and treatment facilities were often limited and or restricted [ 16 , 18 ]. Telemedicine has been reported as one of the adaptation measures which enhanced the continuation of care for amyloidosis patients during the early stages of the pandemic [ 16 , 18 , 22 , 23 ].…”

“…Furthermore, those with new or relapsing disease were likely to experience delays in diagnostics and treatment facilities were often limited and or restricted [ 16 , 18 ]. Telemedicine has been reported as one of the adaptation measures which enhanced the continuation of care for amyloidosis patients during the early stages of the pandemic [ 16 , 18 , 22 , 23 ]. However, the protective role of telemedicine in preventing exposure to COVID-19, might have inevitably come at the cost of sub-optimal care that is delivered virtually.…”

“…However, the protective role of telemedicine in preventing exposure to COVID-19, might have inevitably come at the cost of sub-optimal care that is delivered virtually. Lewis et al [ 16 ] reported a 36% reduction in the diagnosis of AL amyloidosis in 2020 compared to 2019. This likely reflects a reduction in patients self-presenting due to fear of accessing healthcare services or attributing systemic symptoms as not significant enough to warrant a clinician review.…”

Viruses and amyloids - a vicious liaison

“…Vascular association of SARS-CoV-2 infection is likely detrimental and a possible worsening of ongoing ATTR amyloidosis [ 142 ]. Systemic amyloidosis patients (AL and ATTR) showed excess mortality when suffering from COVID-19 compared to otherwise healthy individuals [ 143 ].…”