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Background: The significance of antiphospholipid antibodies (aPL) in COVID-19 remains uncertain. Objectives: We determined whether aPL are associated with COVID-19 and/or thrombosis or adverse outcomes during hospitalization for COVID-19. Methods: Symptomatic adults tested for SARS-CoV-2 for clinical reasons (March-July 2020) with either ≥1 positive polymerase chain reaction (COVID-19+) or all negative (non-COVID-19) results were recruited to a biobank collecting plasma, clinical data, and outcomes. We tested baseline plasma samples (days 0-7) of all subjects (and day-30 samples in the COVID-19+ subjects, when available) for aPL (anticardiolipin immunoglobulin [Ig]M/IgG, anti-ß2-glycoprotein I IgM/IgG, antiphosphatidylserine/prothrombin IgM/IgG, and lupus anticoagulant). We compared the baseline prevalence of aPL between the COVID-19+ and non-COVID-19 subjects. Among hospitalized COVID-19+ subjects, multivariable logistic regression was used to evaluate the association of aPL (and their subtypes) with arterial or venous thromboembolic events, acute kidney injury, intensive care unit admission, mechanical ventilation, and death after adjusting for potential confounders. Results: At baseline, 123 of 289 (43%) COVID+ subjects had ≥1 aPL versus 116 of 261 (32%) non-COVID-19 subjects (difference, 10%; 95% CI, 3%-18%). Among 89 COVID+ subjects with repeated samples, aPL persisted on day 30 in 15 of 34 (44%) subjects with baseline aPL positivity, and half of those without aPL at baseline developed one or more new aPL. In hospitalized COVID-19 subjects (n = 241), baseline aPL positivity was associated with acute kidney injury (odds ratio [OR], 1.8; 95% CI, 1.1-3.2) and mechanical ventilation (OR, 3.2; 95% CI, 1.5-6.8) but not death (OR, 1.2; 95% CI, 0.6-2.5). In secondary analyses, medium-to-high titers of anticardiolipin IgG (>40) were associated with thromboembolic events (OR, 7.3; 95% CI, 1.8-30.1). Conclusion: In patients with COVID-19, aPL may help identify an increased risk of thrombosis and other adverse outcomes.
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OBJECTIVE: To investigate the incidence of and factors associated with SARS-CoV-2 testing and infection in immune-mediated inflammatory disease (IMID) patients versus matched non-IMID comparators from the general population. METHODS: We conducted a population-based, matched cohort study among adult residents from Ontario, Canada, from January 2020 to December 2020. We created cohorts for the following IMIDs: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis, systemic autoimmune rheumatic diseases, multiple sclerosis (MS), iritis, inflammatory bowel disease (IBD), polymyalgia rheumatica, and vasculitis. Each patient was matched with 5 patients without IMIDs based on sociodemographic factors. We estimated the incidence of SARS-CoV-2 testing and infection in IMID patients and non-IMID patients. Multivariable logistic regressions assessed odds of SARS-CoV-2 infection. RESULTS: We studied 493,499 patients with IMIDs and 2,466,946 patients without IMIDs. Patients with IMIDs were more likely to have at least 1 SARS-CoV-2 test versus patients without IMIDs (27.4% versus 22.7%), but the proportion testing positive for SARS-CoV-2 was identical (0.9% in both groups). Overall, IMID patients had 20% higher odds of being tested for SARS-CoV-2 (odds ratio 1.20 [95% confidence interval 1.19-1.21]). The odds of SARS-CoV-2 infection varied across IMID groups but was not significantly elevated for most IMID groups compared with non-IMID comparators. The odds of SARS-CoV-2 infection was lower in IBD and MS and marginally higher in RA and iritis. CONCLUSION: Patients across all IMIDs were more likely to be tested for SARS-CoV-2 versus those without IMIDs. The risk of SARS-CoV-2 infection varied across disease subgroups.
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BackgroundPeople with SLE (and their doctors) are concerned about the risk of COVID-19 infection, yet some patients still harbor concerns regarding vaccination. The first mRNA SARS-CoV-2 vaccines were not studied in this population.1, 2 To address this knowledge gap, we evaluated the safety and side effects of mRNA SARS-CoV-2 vaccines in people with SLE.MethodsAt a Canadian tertiary care centre, we studied SLE cohort patients who were followed with standardized annual assessments. From January 2021 to May 2022, 345 SLE patients consecutively seen for their annual research visit reported information on SARS-CoV-2 vaccinations. We performed descriptive data analysis on the type of vaccination received, side effects, ER visits, and hospitalizations.ResultThe patients were mostly female (n=306, 88.7%) and Caucasian (n=209, 60.6%) and the average SLE duration was 19.7 years (SD 11.9). Most patients (n=298, 86.4%) had received at least one SARS- CoV-2 vaccination and 248 (71.9%) has received at least 2 doses. Specifically, 50 (14.5%) had received one dose, 150 (43.5%) had received 2 doses and 98 (28.4%) had received at least 3. Most (n=181, 60.7%) of initial doses were Pfizer, followed by Moderna (n=54, 18.1%), AstraZeneca (n=12, 4.0%) and Johnson & Johnson (n=1, 0.3%). (The remaining (n=50, 16.8%) were unknown type.) About two-thirds (n=159, 63.3%) of the second doses were Pfizer, and 49 (19.5%) were Moderna.Among those receiving at least 1 vaccination dose, 34 of 128 patients who responded to the question reported symptoms post-vaccine (26.6%). The most common symptoms were fever and injection- related arm pain;both were reported at equal frequency (n=9, 7.0%). Other symptoms were fatigue and headache (n=6, 4.6% for both). There were 3 cases of myalgia and 2 cases of arthralgia. One patient reported hypertension after the first dose of vaccine which required a short 24h ER visit. The remaining did not specify their symptoms. No patients reported disease flare in the post vaccination period.Amongst those who provided information about SARS-CoV-2 infection (n=243), 19.3% reported testing positive for SARS-CoV-2. Only one patient required hospitalization for SARS-CoV-2 infection and was vaccine naïve at the time.ConclusionSARS-CoV-2 mRNA vaccine side effects in this SLE population were reported in about a quarter of subjects but symptoms were mild, similar to reports in the general population. We did not detect any side effects requiring hospitalization. Since, in our cohort, the one subject requiring hospitalization for SARS-CoV-2 infection was vaccine-naïve, a benefit for SARS-CoV-2 vaccination in SLE seems evident.ReferencesPolack FP et al;C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid- 19 Vaccine. N Engl J Med. 2020;383(27):2603–2615. doi: 10.1056/NEJMoa2034577.Baden LR et al. COVE Study Group. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5):403–416. doi: 10.1056/NEJMoa2035389.
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BACKGROUND: Few reports exist on the characteristics and outcomes of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in immunocompromised hosts. METHODS: A 49-year-old patient with granulomatosis with polyangiitis (GPA) and a renal transplant experienced multiple hospitalizations for coronavirus disease 2019 (COVID-19) pneumonia and relapses between October 2020 and February 2021. Careful chart review of medical history, hospitalizations, and microbiological testing including SARS-CoV-2 cycle threshold values, therapies, and imaging was undertaken. SARS-CoV-2 genome sequencing was performed in five viral samples to distinguish persistent infection from re-infection with a different strain. RESULTS: Sequencing confirmed that all samples tested were from the same viral lineage, indicating a long-term, persistent infection rather than re-infection with a new strain. The patient ultimately stabilized after two courses of remdesivir plus dexamethasone, replacement intravenous immunoglobulin, and bamlanivimab. Rituximab maintenance therapy for vasculitis remains on hold. CONCLUSIONS: SARS-CoV-2 may persist for several months in immunocompromised hosts and may go unrecognized as an ongoing active infection. More studies are needed to determine how to optimize COVID-19 treatment in this vulnerable population.
HISTORIQUE: Il existe peu de rapports sur les caractéristiques et les issues de l'infection par le coronavirus 2 du syndrome respiratoire aigu sévère (SRAS-CoV-2) chez les hôtes immunodéprimés. MÉTHODOLOGIE: UNE PATIENTE de 49 ans receveuse d'une transplantation rénale atteinte d'une granulomatose avec polyangéite a été hospitalisée à de multiples reprises à cause d'une pneumonie à maladie à coronavirus 2019 (COVID-19) et de récidives entre octobre 2020 et février 2021. Les chercheurs ont exécuté une analyse attentive du dossier pour connaître l'histoire médicale de la patiente, les hospitalisations et les tests microbiologiques effectués, y compris les valeurs seuils du cycle du SRAS-CoV-2, les traitements et les techniques d'imagerie. Ils ont procédé au séquençage du génome du SRAS-CoV-2 dans cinq prélèvements viraux pour distinguer l'infection persistante de la réinfection par une souche différente. RÉSULTATS : Le séquençage a confirmé que tous les prélèvements effectués provenaient de la même lignée virale, ce qui détermine une infection persistante prolongée plutôt qu'une réinfection par une nouvelle souche. L'état de la patiente a fini par se stabiliser après deux traitements au remdésivir combiné à de la dexaméthasone, une thérapie de substitution par immunoglobuline intraveineuse et du bamlanivimab. Un traitement d'entretien de la vasculite au rituximab demeure en suspens. CONCLUSIONS: Le SRAS-CoV-2 peut persister plusieurs mois chez les hôtes immunodéprimés, et un état d'infection active continue peut passer inaperçu. Plus d'études devront être réalisées pour déterminer le moyen d'optimiser le traitement de la COVID-19 dans cette population vulnérable.
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OBJECTIVE: To investigate coronavirus disease 2019 (COVID-19) hospitalization risk in patients with immune-mediated inflammatory diseases (IMIDs) compared with matched non-IMID comparators from the general population. METHODS: We conducted a population-based, matched cohort study using health administrative data from January to July 2020 in Ontario, Canada. Cohorts for each of the following IMIDs were assembled: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PsA), ankylosing spondylitis, systemic autoimmune rheumatic diseases (SARDs), multiple sclerosis (MS), iritis, inflammatory bowel disease, polymyalgia rheumatica, and vasculitis. Each patient was matched with 5 non-IMID comparators based on sociodemographic factors. We compared the cumulative incidence of hospitalizations for COVID-19 and their outcomes between IMID and non-IMID patients. RESULTS: A total of 493,499 patients with IMID (417 hospitalizations) and 2,466,946 non-IMID comparators (1519 hospitalizations) were assessed. The odds of being hospitalized for COVID-19 were significantly higher in patients with IMIDs compared with their matched non-IMID comparators (matched unadjusted odds ratio [OR] 1.37, adjusted OR 1.23). Significantly higher risk of hospitalizations was found in patients with iritis (OR 1.46), MS (OR 1.83), PsA (OR 2.20), RA (OR 1.42), SARDs (OR 1.47), and vasculitis (OR 2.07). COVID-19 hospitalizations were associated with older age, male sex, long-term care residence, multimorbidity, and lower income. The odds of complicated hospitalizations were 21% higher among all IMID vs matched non-IMID patients, but this association was attenuated after adjusting for demographic factors and comorbidities. CONCLUSION: Patients with IMIDs were at higher risk of being hospitalized with COVID-19. This risk was explained in part by their comorbidities.