Clinical outcomes of breakthrough COVID-19 after booster vaccination in patients with systemic rheumatic diseases

Fragoulis, G.; Karamanakos, Anastasios; Arida, Aikaterini; Bournia, Vasiliki-Kalliopi; Evangelatos, Gerasimos; Fanouriakis, Antonis; Fragiadaki, Kalliopi; Kravvariti, Evrydiki; Laskari, Katerina; Panopoulos, Stylianos; Papazoglou, N; Παππά, Μαρία; Tektonidou, Maria G.; Sfikakis, Petros P.

doi:10.1136/rmdopen-2022-002279

Cited by 20 publications

(23 citation statements)

References 7 publications

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“…Despite vaccines have impeded the consequences of COVID-19,4 infections with adverse outcomes can occur in patients with SRD. To further decrease COVID-19 reated morbidity and mortality in high-risk patients, two oral antiviral therapies (molnupiravir and nirmatrelvir/ritonavir combination) have been approved for the outpatient treatment of patients at risk for progression to severe COVID-19 5…”

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confidence: 99%

Oral antiviral treatment in patients with systemic rheumatic disease at risk for development of severe COVID-19: a case series

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Oral antiviral treatment in patients with systemic rheumatic disease at risk for development of severe COVID-19: a case series

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“…Transplant recipients were at a substantially increased risk of severe COVID-19 outcomes, whereas patients with ARDs were at no increased risk for many outcomes and a mild or moderately increased risk for others, specifically patients with RA, PsO/PsA, AS, SARDs overall, SLE and adult systemic vasculitides. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis and early intervention with available therapies, [41][42][43] should be prioritised in these groups according to risk.…”

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confidence: 99%

Severe COVID-19 outcomes among patients with autoimmune rheumatic diseases or transplantation: a population-based matched cohort study

Marozoff

Loree

et al. 2022

BMJ Open

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ObjectivesTo assess the risk of severe COVID-19 outcomes in patients with autoimmune rheumatic diseases (ARDs) and transplant recipients compared with matched general population comparators.DesignPopulation-based matched cohort study using administrative health data sets.SettingBritish Columbia, Canada.ParticipantsAll adults with test-positive SARS-CoV-2 infections. SARS-CoV-2-positive patients with ARDs and those with transplantation were matched to SARS-CoV-2-positive general population comparators on age (±5 years), sex, month/year of initial positive SARS-CoV-2 test and health authority.Outcome measuresCOVID-19-related hospitalisations, intensive care unit (ICU) admissions, invasive ventilation and COVID-19-specific mortality. We performed multivariable conditional logistic regression models adjusting for socioeconomic status, Charlson Comorbidity Index, hypertension, rural address and number of previous COVID-19 PCR tests.ResultsAmong 6279 patients with ARDs and 222 transplant recipients, all SARS-CoV-2 test positive, risk of hospitalisation was significantly increased among patients with ARDs (overall ARDs (adjusted OR (aOR) 1.30; 95% CI 1.19 to 1.43)); highest within ARDs: adult systemic vasculitides (aOR 2.18; 95% CI 1.17 to 4.05) and transplantation (aOR 10.56; 95% CI 6.88 to 16.22). Odds of ICU admission were significantly increased among patients with ARDs (overall ARDs (aOR 1.30; 95% CI 1.11 to 1.51)); highest within ARDs: ankylosing spondylitis (aOR 2.03; 95% CI 1.18 to 3.50) and transplantation (aOR 8.13; 95% CI 4.76 to 13.91). Odds of invasive ventilation were significantly increased among patients with ARDs (overall ARDs (aOR 1.60; 95% CI 1.27 to 2.01)); highest within ARDs: ankylosing spondylitis (aOR 2.63; 95% CI 1.14 to 6.06) and transplantation (aOR 8.64; 95% CI 3.81 to 19.61). Risk of COVID-19-specific mortality was increased among patients with ARDs (overall ARDs (aOR 1.24; 95% CI 1.05 to 1.47)); highest within ARDs: ankylosing spondylitis (aOR 2.15; 95% CI 1.02 to 4.55) and transplantation (aOR 5.48; 95% CI 2.82 to 10.63).ConclusionsThe risk of severe COVID-19 outcomes is increased in certain patient groups with ARDs or transplantation, although the magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis and early intervention with available therapies, should be prioritised in these groups according to risk.

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“…Despite these observations, the small number of severe outcomes may provide reassurance that vaccinations offer protection against hospitalization and death even among immunosuppressed patients with SARDs. 28…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with COVID-19 Breakthrough Infection in the Pre-Omicron Era Among Vaccinated Patients with Rheumatic Diseases: A Cohort Study

Patel

Wang

et al. 2022

Preprint

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Objective: Rheumatic disease patients on certain immunomodulators are at increased risk of impaired humoral response to SARS-CoV-2 vaccines. We aimed to identify factors associated with breakthrough infection among patients with rheumatic diseases. Methods: We identified patients with rheumatic diseases being treated with immunomodulators in a large healthcare system who received at least two doses of either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) vaccines or one dose of the Johnson & Johnson-Janssen (J&J) vaccine. We followed patients until SARS-CoV-2 infection, death, or December 15, 2021, when the Omicron variant became dominant in our region. We estimated the association of baseline characteristics with the risk of breakthrough infection using multivariable Cox regression. Results: We analyzed 11,468 patients (75% female, mean age 60 years). Compared to antimalarial monotherapy, multiple immunomodulators were associated with higher risk of infection: anti-CD20 monoclonal antibodies (aHR 5.20, 95% CI: 2.85, 9.48), CTLA-4 Ig (aHR 3.52, 95% CI: 1.90, 6.51), mycophenolate (aHR 2.31, 95% CI: 1.25, 4.27), IL-6 inhibitors (aHR 2.15, 95% CI: 1.09, 4.24), JAK inhibitors (aHR 2.02, 95% CI: 1.01, 4.06), and TNF inhibitors (aHR 1.70, 95% CI: 1.09, 2.66). mRNA-1273 recipients had a lower risk of breakthrough infection compared to BNT162b2 recipients (aHR 0.66, 95% CI: 0.50, 0.86). There was no association of sex, body mass index, smoking status, race, or ethnicity with risk of breakthrough infection. Conclusion: Among patients with rheumatic diseases, multiple immunomodulators were associated with increased risk of breakthrough infection. These results highlight the need for additional mitigation strategies in this vulnerable population.

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Clinical outcomes of breakthrough COVID-19 after booster vaccination in patients with systemic rheumatic diseases

Cited by 20 publications

References 7 publications

Oral antiviral treatment in patients with systemic rheumatic disease at risk for development of severe COVID-19: a case series

Oral antiviral treatment in patients with systemic rheumatic disease at risk for development of severe COVID-19: a case series

Severe COVID-19 outcomes among patients with autoimmune rheumatic diseases or transplantation: a population-based matched cohort study

Factors Associated with COVID-19 Breakthrough Infection in the Pre-Omicron Era Among Vaccinated Patients with Rheumatic Diseases: A Cohort Study

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