COVID-19 severity and vaccine breakthrough infections in idiopathic inflammatory myopathies, other systemic autoimmune and inflammatory diseases, and healthy controls: a multicenter cross-sectional study from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) survey

Abstract

Objectives We aimed to compare the spectrum and severity of COVID-19 and vaccine breakthrough infections (BIs) among patients with IIMs, other systemic autoimmune and inflammatory diseases (SAIDs), and healthy controls (HCs). Methods This is a cross-sectional study with data from the COVAD study, a self-reported online global survey that collected demographics, COVID-19 history, and vaccination details from April to September 2021. Adult patients with at least one COVID-19 vaccine dose were included. BIs were defined as infections occurring > 2 weeks after any dose of vaccine. Characteristics associated with BI were analyzed with a multivariate regression analysis. Results Among 10,900 respondents [42 (30–55) years, 74%-females, 45%-Caucasians] HCs were (47%), SAIDs (42%) and IIMs (11%). Patients with IIMs reported fewer COVID-19 cases before vaccination (6.2%-IIM vs 10.5%-SAIDs vs 14.6%-HC; OR = 0.6, 95% CI 0.4–0.8, and OR = 0.3, 95% CI 0.2–0.5, respectively). BIs were uncommon (1.4%-IIM; 1.9%-SAIDs; 3.2%-HC) and occurred in 17 IIM patients, 13 of whom were on immunosuppressants, and 3(18%) required hospitalization. All-cause hospitalization was higher in patients with IIM compared to HCs [23 (30%) vs 59 (8%), OR = 2.5, 95% CI 1.2–5.1 before vaccination, and 3 (18%) vs 9 (5%), OR = 2.6, 95% CI 1.3–5.3 in BI]. In a multivariate regression analysis, age 30–60 years was associated with a lower odds of BI (OR = 0.7, 95% CI 0.5–1.0), while the use of immunosuppressants had a higher odds of BI (OR = 1.6, 95% CI 1.1–2.7). Conclusions Patients with IIMs reported fewer COVID-19 cases than HCs and other SAIDs, but had higher odds of all-cause hospitalization from COVID-19 than HCs. BIs were associated with the use of immunosuppressants and were uncommon in IIMs.

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

“…Regarding immunosuppressive treatment, the duration of therapy, the type of drugs, and the dose of glucocorticoids are important factors that may differently affect the disease course 4–7 . Lastly, the response to COVID‐19 vaccines could be less efficient in AIRD patients due to immunosuppressive treatment or underlying immune dysregulation 7,8 . This may contribute to the more severe disease course in AIRD patients despite vaccination.…”

Correlates of breakthrough Omicron (B.1.1.529) infections in a prospective cohort of vaccinated patients with rheumatic diseases

“…Infections with Omicron were observed across India from January 2022 onwards [ 2 ]. Previous studies had shown a modest decline in vaccine effectiveness against the delta variant from the original alpha strain in terms of breakthrough infections [ 3 – 6 ]. Patients with autoimmune rheumatic diseases are at increased risk for severe COVID-19 due to their medications and prevalent comorbidities [ 7 ].…”

Reply to “Letter to the Editor Regarding ‘COVID-19 outcomes in patients with Dermatomyositis: A registry-based cohort analysis’”

“…We appreciate that disease activity is an aspect that we would like to explore as it is likely to be relevant to outcomes, and hope that some ongoing studies with big-datasets answer these important questions. [3] , [4] , [5] With successful worldwide global vaccination, pre-vaccination outcomes are harder to explore and persistent hesitancy as well as infection induced flares may be more pertinent questions to explore. SARS-CoV2 epitopes have been identified to bear sequence homology with T cell receptors in dermatomyositis, substantiating plausible links between viral triggers for autoimmunity.…”

“…Hoff et al identified higher odds of breakthrough infection in IIM patients receiving intense immunosuppression, reiterating that immunosuppression defined risk stratification would be an ideal approach to inform booster dose schedules. 3 We would be interested in exploring data on antibody response to previous COVID-19 infection and vaccination and its interplay with immunosuppressant received in different subtypes of DM. We hope that despite the rarity of this condition and ethnic and environmental factors that may be at play, big datasets set in the real world offer insights in this direction.…”

“…However, age in general is a key confounding variable, both for outcomes of COVID-19 in general, and myositis in specific, with individuals aged 30-60 being protected from breakthrough infections and worse outcomes. 3 …”