ABSTRACT
Background: Vulnerable subjects, including systemic lupus erythematosus (SLE) patients have been prioritised to receive anti-SARS-CoV-2 vaccine. Questions have been raised about the effect of vaccines on immunity and their potential role as trigger for fare. Few data about the safety of these vaccines in SLE are available Objectives: To investigate the safety of different anti-SARS-CoV-2 vaccines in SLE Methods: Data on SLE patients who have received anti-SARS-CoV-2 vaccine (from 12/2020 to 10/2021) were collected. Patients referred to 7 SLE tertiary centres (Lupus Clinic, ASST Pini-CTO, Milan;Nephrology Unit of Ospedale Giovanni Bosco, Turin;IRCCS Humanitas Research Hospital;Renal and Rheumatology Units, San Gerardo Hospital, Monza;ASST Spedali Civili Brescia;Lupus Clinic IRCCS Ospedale S. Raffaele, Milan, Italy;IRCCS Policlinico, Milan) Results: 452 SLE patients who had received anti-SARS-CoV-2 vaccines were included (91% BNT162b2 mRNA, 8% mRNA-1273, 1% ChAdOx1-S). 12 (3%) were off therapy, 71% were on low-medium dose prednisone, 83% on anti-ma-larials, 50% were treated with an immunosuppressant. 9 patients transiently discontinued therapy. 119 (26%) reported adverse symptoms after the frst/second shot (12% and 21%) The most frequent were fever, local reaction, fatigue and arthralgias. Nineteen (4%) patients fared up after immunisation with a 7 days median time to relapse. Baseline demographics, SLE characteristics and therapy stratifed by adverse events and disease fare are reported in Table 1. Anti-dsDNA positivity, moderate/high DAS before vaccine and use of Belimumab were sig-nifcantly more frequent in the group of patients fared. These patients displayed a signifcantly higher rate of adverse events after vaccination. Flares consisted mainly musculoskeletal and constitutional manifestations (32%), involvement of renal (21%), cardio-respiratory (16%), hematological (16%) or mucocutaneous domains (10%) was less frequent Conclusion: our reassuring data confrm that anti-SARS-CoV-2 vaccine is safe in SLE patients and should be recommended in this clinical setting, as potential benefts widely outweigh the risk of adverse events. Treatment adjustment might be considered with the aim of minimizing the risk of side effects and/or fare, while ensuring a satisfying protection against infection.
ABSTRACT
Introduction: The ongoing SARS-COV-2 pandemic hit the world’s population since the first trimester of 2020. Since the beginning it has been clear that the elderly and chronic patients were at greater risk ofmorbidity and mortality. The aim of the study was to monitor the spread and outcomes amongpatients in kidney replacement therapy treated in Nephrology-Dialysis units in Piedmont and Valled’Aosta Regions, North-West Italy. Methods: A web platform accessible by Dialysis coordinators across the first and second wave of the pandemic is still being used to collect and regularly update demographic and clinical data of patients. We present preliminary results on cumulative incidence, risk estimates and measures of association. Data were analyzed using SPSS version 19 and Wizard 1.9.47 for Mac. Results: An overall of 599 cases has been monitored since March 2020 till November 2020. The cumulative incidence is 10% compared to 3,3% of the general population. A higher cumulative incidence has been observed among Hemodialysis patients (14%), while in peritoneal dialysis patients and transplant receivers’ sub-groups it is 5,3% and 6,6%, respectively. Compared to the general population, among dialysis patients, cumulative incidence grew at a slower rate in the first than in the second wave of pandemic (incidence rate ratio of 1,65 for patients compared to 5,9 for the rest of the population). A higher fatality risk is observed among dialysis patients and transplant receivers (17% and11%, respectively) compared to that of the general population of 3,7%. Fatality is associated with age and cardiovascular diseases in both groups. Conclusions: The study of an overall population of 599 showed a higher susceptibility to SARS-COV-2 infection and worse outcomes compared to the general population. We observed increased risks for hemodialysis patients, who are older on average and more exposed to in-hospital infections. No conflict of interest
ABSTRACT
Introduction Various coagulation alterations have been reported in COVID-19 patients, especially in those with the most severe forms: A) elevated d-dimer (x6 time normal value) correlates with poor prognosis;b) low-molecular weight heparins have been reported as an effective drug to support intensive care;c) thrombosis of the pulmonary vessels has often been found at the autoptic investigation of COVID-19 patients. It is well-known that bacterial and viral infections can induce antiphospholipid antibodies (aPL), which is often not associated to thrombotic events. A recent study reported the presence of aPL mainly of IgA isotype (not part of laboratory work-out for APS), in COVID-19 positive patients, they did not specify the aPL titres and LAC testing was not available. Most importantly from a clinical point of view, all the reported patients have suffered in the past for vascular manifestations. In order to better understand the SARS-2-Cov 2 coagulopathy, we performed an observational study aiming to investigate the status of haemostasis in these patients, performing a panel of coagulation markers. Patients and methods 101 consecutive PCR-confirmed COVID-19 infected patients admitted at the AO Ordine Mauriziano Hospital, Torino, Italy, were included in this study. Patients were tested for aPL profile, D-Dimer, von Willebrand factor, and IL-6 levels. Patients defined as critically ill were those hospitalized in an intensive care unit at the time of the blood withdrawal. Results Our data showed positivity for any aPL in about half of the patients (48.5%). In detail, we found that a positivity for Lupus Anticoagulant (LAC) can be detected in up to 1 out of 3 symptomatic COVID-19 patients when tested according to the ISTH. However, the so called triple aPL positivity, the profile most strongly associated with a thrombotic event in patients with APS (the concomitant presence of LAC, anticardiolipin IgG and anti-beta2GPI IgG antibodies) has been observed in only one patient (1%). When including any triple positivity (for LAC plus anticardiolipin and anti-beta2-GPI either IgG/IgM) we were able to identify 3 patients (3%). More importantly, most of aPL positivity was detected at the low-medium titre;aPL positivity are known to be detectable during infections, to include viral diseases such as HIV and hepatitis C. The presence of aPL in these contexts is often transient and almost always non-specific (nonthrombosis-related). Discussion In conclusion, although isolated, LAC positivity is present in about a third of patients. Their clinical role in the pathogenesis of a coagulopathy and pulmonary thrombosis during COVID-19 infection still need to be demonstrated.