ABSTRACT
Recent evidence shows that COVID-19 infection does not have a worse prognosis in patients with immune-mediated inflammatory diseases (IMID), although they develop a worse response to vaccination.Objective To compare the incidence of COVID-19 and clinical features in patients with IMID between the first and sixth waves.Method Prospective observational study of two cohorts of IMID patients diagnosed with COVID-19. First cohort March to May 2020, and second cohort December/2021 to February/2022.Sociodemographic and clinical variables were collected and, in the second cohort, COVID-19 vaccination status. Statistical analysis established differences in characteristics and clinical course between the two cohorts.Results In total, 1627 patients were followed up, of whom 77 (4.60%) contracted COVID-19 during the first wave and 184 in the sixth wave (11.3%). In the sixth wave, there were fewer hospitalisations, intensive care unit admissions, and deaths than in the first wave (p=.000) and 180 patients (97.8%) had at least one dose of vaccine.Conclusion Early detection and vaccination have prevented the occurrence of serious complications.
ABSTRACT
Las últimas evidencias revelan que la infección por Covid-19 no tienen peor pronóstico en los pacientes con enfermedades inflamatorias inmunomediadas (EIMI), aunque desarrollan menor respuesta a la vacunación. Objetivo Comparar la incidencia de COVID-19 y características clínicas en pacientes EIMI entre la primera y sexta olas. Método Estudio observacional prospectivo de dos cohortes de pacientes con EIMI diagnosticados de COVID-19. Primera cohorte: marzo-mayo de 2020, y la segunda diciembre/2021 a febrero/2022. Se recogieron variables sociodemográficas y clínicas y, en la segunda cohorte, estado de vacunación contra la covid-19. El análisis estadístico estableció las diferencias de las características y evolución clínica entre ambas cohortes. Resultados De un total de 1627 pacientes en seguimiento, contrajeron Covid-19 durante la primera ola 77 (4.60%) y 184 en la sexta (11.3%). En la sexta hubo menos hospitalizaciones, ingresos en Cuidados Intensivos y fallecimientos que en la primera (p=0.000) y 180 pacientes (97.8%) tenían al menos una dosis de vacuna. Conclusión La detección precoz y la vacunación han evitado la aparición de complicaciones graves.
ABSTRACT
by Covid-19Objective: Describe the incidence of Covid-19 by sex and specialty in patients with Immune-Mediated Inflammatory Disease (IMID). Methods: Prospective observational study of patients in treatment at a Centre for ImmuneMediated Inflammatory Diseases, march to june 2020. Results: The patients in follow-up were 1672, 3480 consultations were carried out, 2382 were telematic (68.4 %). The cases of covid-19 were 77 (4.60 %), were women 40 (51.98 %). The prevalent symptoms were: seca (81.8 %), myalgia/arthralgia (77.9 %), headache (68.8 %), fever (55.8 %) and pneumonia (22.4 %). Statistical differences were found in symptoms by specialty: myalgia / arthralgia (p=0.001), headache (p=0.011), fever (p=0.012). Hospital admission was required in 17 (22.10 %) patients and 3 (17.65 %) in the Intensive Care Unit. Conclusions: Biological drug therapy was not associated with worse Covid-19 outcomes. Telematic consultations carried out by Advanced Nurse Practitioner ensured optimal follow-up, early detection and continuity of treatment.
ABSTRACT
Background: There's little data of patients with immune diseases (ID) treated with biologic and JAK-inhibitors and COVID19. Current consensus is to keep treatment, however more studies are needed to ascertain the risk in these patients. Objectives: To describe the associated risk factors and outcomes in hospitalized patients with ID treated with biologics and JAK-inhibitors of a tertiary center. Methods: Observational retrospective study of patients with COVID19 from March 1st 2020 to January 31st 2021. Out of all the patients receiving subcutaneous (SC) or intravenous (IV) biologics and oral (PO) JAK-inhibitors, we selected those requiring hospitalization due to pneumonia for analysis. We collected demographic data, comorbidities, seasonal flu vaccination, smoking history and the outcome (discharge/admission in an intensive care unit (ICU)/death). We used a composite index (Charlston's index) for comorbidities. Results: Of 153 patients, 29 (18.9%) were hospitalized. 18 (62%) were women with a median age of 61 (IQ 52-69). 14 (48.2%) had rheumatoid arthritis, 5 (17%) had axial spondylarthritis and 4 (13.7%) had Chron's disease. The main IV was Rituximab in 3 (50%), and abatacept, infliximab and vedolizumab had one each. Of the SC, tocilizumab and adalimumab had 5 (22.7%) each, etanecept and golimumab had 3 (13.6%) each and secukinumab, ustekinumab and abatacept had 2 (9%) each. The PO was tofacitinib. There were no outcome differences for each treatment. 24 (82.7%) patients had at least 1 comorbidity with significative difference between patients (Table 1). There were 6 (20.6%) deaths, 3 (50%) in the ICU, 2 (33%) did not meet the ICU criteria, and 1 (16%) before ICU admission. None them had the same ID. Conclusion: The rate of COVID19 hospitalization in our patients was comparable to the general population's (between 19-24% from 60 years plus) and the risk of in-patient death is also similar, around 24%1. Our study suggests that neither their ID nor their treatment influences their risk of a worse outcome. COPD, DM and previous heart disease were associated with worse outcome;however it seems that the main prognostic factor was the overall impact of comorbidities associated;as measured by the Charlston's index, being significantly higher in the patients with a fatal outcome. A fatal outcome was more likely in IV biologics, however it could be explained by indication bias probably due to higher comorbidity and disability in these patients rather than an independent prognostic variable.