SAFETY of SARS-COV-2 VACCINES in PATIENTS with AUTOIMMUNE DISEASES

Background: Patients (pts) with autoimmune diseases are at higher risk of infections, including those by SARS-COV-2. There is no general agreement regarding priority criteria for anti-COVID vaccine access for pts with autoimmune rheumatic diseases (ARD). Few studies have addressed the issue of anti-COVID vaccination in these pts, but many are available on the safety, immunogenicity, efficacy, and possible contraindications of traditional vaccines in pts with ARD. These studies may represent the basis on which to recommend the anti-COVID-19 vaccines. Objectives: Patients (pts) with autoimmune diseases are at higher risk of infections, including those by SARS-COV-2. There is no general agreement regarding priority criteria for anti-COVID vaccine access for pts with autoimmune rheumatic diseases (ARD). Few studies have addressed the issue of anti-COVID vaccination in these pts, but many are available on the safety, immunogenicity, efficacy, and possible contraindications of traditional vaccines in pts with ARD. These studies may represent the basis on which to recommend the anti-COVID-19 vaccines. Methods: A telephone survey investigating the AE of SARS-CoV-2 vaccinations on pts with systemic lupus erythematosus, systemic sclerosis, infammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis), idiopathic infammatory myopathies, ANCA-associated vasculitis was administered. Data extraction included diagnosis, disease activity status, demographics, disease duration, therapy, comor-bidities, and laboratory tests. Vaccinated participants are asked to report whether they experienced any local or systemic AE following vaccination, and if so, to report on the severity and duration of the AE. Mild AE were defned as unpleasant reactions that did not limit daily activities, moderate AE as those that limited daily activities, and severe AE-required medical attention. Serious AE were defned as reactions that resulted in hospital admission. Results: ChAdOx1 nCoV-19 and BNT162b2 are the most common vaccines in our pts. 98 (39,84 %) of 246 pts received the BNT162b2 vaccine, 95 (38,62 %)-ChA-dOx1 nCoV-19 vaccine, 47 (19,10%)-CX-024414 and 6 (2,44 %) were vaccinated with Ad26.COV2-S. 127 (51,63%) pts had at least one mild AE and 51 (20,73 %) pts reported moderate AE. Severe AE were rare-4 (1,63 %) pts and no serious AE were reported. The most commonly reported AE is pain (40,24 %), redness (30,49 %), swelling (18,7 %) at the injection site, which was consistent across all vaccines for both frst and second doses. Systemic AE occurred in 104 (43,27 %) pts, most frequently fatigue (29,67 %), headache (27,13 %) and muscle ache (24,39 %). The symptoms started mostly during the frst day post-vaccination and lasted for no more than two days. Joint complaints were reported in 8,94 %, but only a small proportion of pts (2,84 %) reported a deterioration of their autoimmune disease up to 3 months after COVID-19 vaccination. Age was a signifcant effect modifer in the association between autoimmune status and the risk of moderate or severe AE. Vaccination with ChAdOx1 nCoV-19, female sex, age between 35-50 years were independently associated with an increased likelihood of reporting any AE. The current results support the safety of different COVID-19 vaccines in pts with ARD. This information can help fght vaccine hesitancy in this population. Conclusion: Our data indicated that COVID-19 vaccines are well tolerated by pts with ARD. We did not observe any serious AE, but the number of pts included in our study is too low to draw conclusions about rare serious events. Additionally, our data suggest that COVID-19 vaccinations do not seem to trigger autoimmune disease fares, which is in accordance with data from previous small studies that assessed consequences of vaccines in pts with ARD.

Lupus nephritis and covid-19 infection

Objectives: Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities. 1, 2 The aim of this study is to describe clinical characteristics of patients with lupus nephritis (LN) and Corona virus disease 2019 (COVID-19), and to identify baseline variables associated with a severe infection requiring hospitalization. Methods: A telephone survey investigating the impact of COVID-19 on patients with biopsy -proven LN was administered. Data extraction included diagnosis, disease activity status, demographics, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. COVID-19 was classified as definite diagnosis of COVID-19 disease: presence of symptomatic COVID-19 infection, confirmed by nasopharyngeal SARSCoV-2 polymerase chain reaction test. Comparisons between patients with or without hospitalization were performed. Results: 114 patients (median age 34,9 ± 12,4 years) with LN were included in the study. 31 patients (26 women, 5 men) developed at least one symptom (flulike symptoms, chest pain, fever, asthenia, chills, cough, sore throat, dyspnea, headaches, arthromyalgias, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. 31 patients were treated with methylprednisolone, 21 -with hydroxychloroquine, 8 -with azathioprine, 4 -with cyclophosphamide prior to their COVID-19 illness. Conclusion: Covid-19 is more frequent in the subgroup of LNpatients without therapy with hydroxychloroquine, which might play some protective role against the most harmful manifestations of COVID-19. Six patients required hospitalization -these were more frequently men, older and with comorbidities (lung diseases, hypertension) and active LN (3 -class IV LN, 2 -class V LN, 1 -class III LN and 1 -class II LN, according the 2003 ISN/RPS classification). Male sex, previous lung disease, serum creatinine level, proteinuria, glucocorticoids use >5 mg/day, were significantly associated with hospitalization.

Autoimmune systemic diseases and COVID-19 infection

Background: COVID-19 infection poses a serious challenge for immune-compromised patients. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities. Little is known about the impact of Coronavirus disease 2019 (COVID-19) in patients with inflammatory autoimmune systemic diseases. Objectives: The aim of this study is to describe clinical characteristics of patients with autoimmune systemic diseases and COVID-19, and to identify baseline variables associated with a severe infection requiring hospitalization. Methods: A telephone survey investigating the impact of COVID-19 on patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis), idiopathic inflammatory myopathies (IIM), ANCA-associated vasculitis (AAV) was administered. Data extraction included diagnosis, disease activity status, demographics, disease duration, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. COVID-19 was classified as definite diagnosis of COVID-19 disease: presence of symptomatic COVID-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test. Comparisons between patients with or without hospitalization were performed. Results: 512 patients (median age 53,4 ± 14,3 years) with autoimmune systemic diseases (234 IA, 182 SLE, 42 SSc, 31 IIM, 23 AAV) were included in the study. 89 patients (58 woman, 31 men) developed at least one symptom (fever, asthenia, chills, cough, sore throat, dyspnea, chest pain, headaches, arthralgias, myalgias, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. Of patients with COVID -19 infection 54 patients were treated with methylprednisolone, 36 -with methotrexate, 34 -with hydroxychloroquine, 26-with biologics, 10 -with azathioprine, 6 -with cyclophosphamide prior to their COVID-19 illness. Conclusion: COVID-19 is more frequent in the subgroup of patients without therapy with modifying anti-rheumatic drugs, which might play some protective role against the most harmful manifestations of Covid-19. 21 patients required hospitalization -these were more frequently men, older and with comorbidities (cardio-respiratory illness, renal diseases, diabetes mellitus). Male sex, previous coronary and lung disease, serum creatinine level, proteinuria, glucocorticoids use ≥ 5 mg/day, were associated to hospitalization. Patients with inflammatory arthritis do not seen to be at higher risk for infection or a severe course of COVID-19.

Mechanisms of kidney injury in patients with COVID-19

COVID-19 (Coronavirus disease-2019) is a new, infectious disease that mainly damages the lungs and leads to severe respiratoryfailure. Numerous studies have shown varying degrees of kidney injury inpatients infected with SARS-COV-2 (Severe acute respiratory syndrome coronavirus 2). The exact causes of kidney injury are not yet clear. In this article, we present a brief data of the general features of SARS-CoV-2 and describe the etiology and potential mechanisms (direct cytopathic effect, specific immunological mechanisms, "cytokine storm", etc.) of kidney damage in COVID-19. © 2020 Medical Information Center. All rights reserved.

Kidney injuries in COVID-19

Coronavirus disease 2019 (COVID-19) is rapidly spread around the world since its initial appearance in Wuhan, Hubei Province, China. Pulmonary involvement is the main manifestation of the disease. Recent reports highlight the fact that kidney injury is relatively common in this infection and is associated with increased morbidity and mortality. Patients with COVID-19 develop a wide range of glomerular and tubular diseases, which in most cases present clinically with proteinuria, hematuria, leucocyturia, acute kidney injury, progressive reduction of creatinine clearance, metabolic disorders, including metabolic acidosis, hypo- and hypernatremia, hypo- and hyperkalemia, coagulation disorders, and others. It is not yet clear whether the kidney injury is the result of direct kidney infection or from complications, arising in the course of COVID-19. Renal biopsies show varying degrees of acute tubular necrosis, crescentic glomerulonephritis, global or segmental glomerulosclerosis with characteristics of collapsing glomerulopathy, thrombotic microangiopathy and others. In this article, we discuss histomorphological changes and clinical manifestations inpatients with COVID-19 and renal involvement. © 2020 Medical Information Center. All rights reserved.