ABSTRACT
Objectives Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are overlapping autoinflammatory diseases affecting people over 50 years. The diseases are treated with immunosuppressive drugs such as prednisolone, methotrexate, leflunomide and tocilizumab. In this study, we assessed the immunogenicity and safety of SARS-CoV-2 vaccinations in these diseases (based on humoral and cellular immunity). Methods Patients (n=45 GCA, n=33 PMR) visited the outpatient clinic twice: pre-vaccination and 4 weeks after the second dose (BNT162b2 or ChAdOx1 vaccine). Patients with previous SARS-CoV-2 infection were excluded. In both pre-vaccination and post-vaccination samples, anti-Spike antibody concentrations were assessed and compared with age-, sex-and vaccine-matched control groups (n=98). In addition, the frequency of SARS-CoV-2 Spike-specific T-cells was assessed by IFN-gammaELIspot assay, and side effects and disease activity were recorded. Results GCA/PMR patients did not have reduced antibody concentrations compared with controls. However, linear regression analysis revealed a significant association of methotrexate and >10 mg/day prednisolone use with lower antibody concentrations in GCA/PMR patients. Evidence of cellular immunity, as assessed by ELIspot assay, was found in 67% of GCA/PMR patients. Patients using >10 mg/day prednisolone had reduced cellular immunity. Importantly, vaccination did not lead to significant side effects or changes in disease activity. Conclusions SARS-CoV-2 vaccination was safe for GCA/PMR patients and immunogenicity was comparable to other older individuals. However, patients using methotrexate and particularly >10 mg/day prednisolone did show lower vaccine responses, which corroborates findings in other autoinflammatory patient populations. These patients may therefore be at higher risk of (potentially even severe) breakthrough SARS-CoV-2 infection. Copyright ©
ABSTRACT
Background: Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are overlapping autoinfammatory diseases affecting people over 50 years. The diseases are treated with immunosuppressive drugs such as prednisolone, metho-trexate, lefunomide and tocilizumab. Even though GCA and PMR patients have a substantially higher risk for infections, little is known about humoral and cellular immune responses after vaccination in these patients. Objectives: In this study we assessed the immunogenicity and safety of SARS-CoV-2 vaccinations in these diseases. Methods: Patients (n=45 GCA, n=33 PMR) visited the outpatient clinic twice: pre-vaccination and 4 weeks post-vaccination (BNT162b2 or ChAdOx1 vaccine). Patients with previous SARS-CoV-2 infection were excluded. In both pre-and post-vaccination samples, anti-Spike antibody concentrations were assessed and compared to age-, sex-and vaccine-matched control groups (n=98). In addition, the frequency of SARS-CoV-2 Spike-specifc T-cells was assessed by IFN-γ ELIspot assay, and side-effects and disease activity were recorded. Results: The GCA/PMR patients, as a group, did not have reduced antibody concentrations compared to controls. However, linear regression analysis revealed a signifcant association of methotrexate and >10mg/day prednisolone use with lower antibody concentrations in GCA/PMR patients. Evidence of cellular immunity, as assessed by ELIspot assay, was found in 67% of GCA/PMR patients, and was correlated with humoral immunity (Figure 1). Patients using >10mg/day prednisolone had reduced cellular immunity. Importantly, vaccination did not lead to signifcant side-effects or changes in disease activity. Conclusion: SARS-CoV-2 vaccination was safe for GCA/PMR patients and immunogenicity was comparable to other older individuals. However, patients using methotrexate and particularly >10mg/day prednisolone did show lower vaccine responses, which corroborates fndings in other autoinfammatory patient populations. These patients may therefore be at higher risk of (potentially even severe) breakthrough SARS-CoV-2 infection.
ABSTRACT
The emergence of COVID-19 pandemic caused a global public health problem. In this article, anxiety and insomnia rates of cancer patients who received chemotherapy during COVID-19 outbreak period were determined. In addition, patients' information and opinions about COVID-19 were discussed. The study included 218 cancer patients who apply to outpatient chemotherapy clinic between May-June 2020, aged 18 and over, who were receiving chemotherapy. Generalized Anxiety Disorder and Insomnia Severity Index questionnaire forms were given to fill the patients to evaluate their anxiety and insomnia levels. We also prepared 12 additional questions about the knowledge and perceptions of COVID-19. Seventy eight (35.8%) patients had anxiety and 106 (48.6%) had insomnia. The rate of whole patients with severe anxiety was 1.8% and with severe insomnia was 2.8%. There was a statistically significant relationship between tumor localization and anxiety (p=0.006). Anxiety scores also increased with the increase in insomnia scores (p< 0.001). Eighty three percent of our patients wore face masks in any environment where they were in contact with people, and 84.9% believed in the protection of the face mask. To the authors'knowledge, this is the first study to examine the anxiety and insomnia rates of the cancer patients receiving chemotherapy in COVID-19 pandemic. The uncertainty of the COVID-19 pandemic process can further increase anxiety and insomnia rates. Patients should be evaluated psychosocially both in the pandemic process and after. Correcting these misperception should be targe-ted in information campaigns, information by clinicians to their patients, and media coverage.