ABSTRACT
Background: Bioinformatics data, which are becoming more detailed day by day, show that male gender, advanced age, smoking, and comorbidities are associated with poor outcome of COVID-19. However, it is well known that the active disease state that may occur as a result of discontinuing the drugs also increases the susceptibility to infection. Objectives: It was aimed to investigate the effects of the COVID-19 pandemic on the course and treatment of rheumatic disease in patients with infammatory rheumatic musculoskeletal disease (iRMD) using biological or targeted synthetic DMARDs (b/tsDMARDs). Methods: The study was carried out in two stages: while investigating the delay of b/tsDMARD treatment in the frst 3 months of the pandemic with the fear of infected by SARS-Cov-2 in the frst stage, in the second stage, it was investigated whether all patients who decided to continue treatment after interruption in the 12-month period. Results: A total of 521 patients were included in the study. It was seen that the iRMD diagnosis were listed as SpA (54.3%), RA (25.7%), PsA (8.4%), vascu-litis (6.1%), and others (5.4%). The overall 12-month drug retention rate was 92.3%. Concurrent use of hydroxychloroquine (HCQ) (HR=1.49), iv bDMARD use (HR=1.34), and a history of discontinuation of drug in the frst 3 months of the pandemic (HR=1.19) were determined as factors that reduced 12-month drug retention rates. During a total of 12 months, 34 (6.5%) of patients had COVID-19. COVID-19 was severe in 7 patients and 5 of these patients died.The use of GC (HR=3.81) and having a diagnosis of ILD/COPD (HR=4.96) were found to increase the risk of infected by SARS-CoV-2. Conclusion: The results of this study with a long follow-up period suggest that the retention rates of b/tsDMARD treatment increased with good communication with iRMD patients during the COVID-19 pandemic.
ABSTRACT
Background: Patients with infammatory rheumatic diseases faced several challenges during the COVID-19 pandemic. Uncertainties such as the lack of evidence regarding the use of immunosuppressive (IS) therapies and deferred patient care because of limited health resources impacted negatively on many aspects of treatment decisions and routine follow-up of the patients (1). Objectives: We aimed to investigate the prevalence and severity of SARS-CoV-2 infection, the impact of the pandemic on delays in routine clinical follow-up, changes in IS treatment, and COVID-19 vaccination status of patients with Takayasu arteritis (TAK). Methods: The study was performed between July and September 2021. TAK patients who registered in our database were investigated with regards to the COVID-19 infection and vaccination status, delays in routine clinical visits, changes in their IS treatments, and fares during the pandemic. Physical examination, laboratory tests, and imaging of the patients were performed and ITAS2010 scores were calculated. Results: There were 56 adult TAK patients (87.5% female and median age 47 years). 44 (78.6%) patients experienced a delay with routine follow-up visits to their physicians and about 20% of patients stopped their antirheumatic treatments without consulting their physicians. Compared to the pre-COVID-19 pandemic, 16 (28.5%) patients were fared. 13 (23.2%) patients had a mild COVID-19 infection. Pneumonia was reported in five patients, two of them required hospi-talization, and all patients recovered completely. In the total group, about 90% of the patients had received the COVID-19 vaccine (Table 1). Conclusion: COVID-19 disease in TAK patients were in mild severity and IS therapy seem not affecting the COVID-19 course. A substantial number of patients who stopped their medications fared and its long-term consequences need to be assessed by large-scale studies. New approaches are required to maximize healthcare access for patients who have chronic diseases during pandemic.
ABSTRACT
Background: Considering the concerns regarding COVID-19 vaccine safety among patients with rheumatic diseases due to a lack of data, an urgent need for studies evaluating safety profiles of vaccines emerged. Objectives: Vaccination against the coronavirus disease-2019 (COVID-19) started in March 2021 in the group using biological therapy in our country. In this study, post-vaccine real-life data of patients with spondyloarthritis (SpA) followed up with biological therapy were analyzed. Methods: Adult patients diagnosed with SpA who were followed up under biological therapy and vaccinated by CoronaVac inactive SARS-CoV-2 orBNT162b2 messenger RNA (mRNA) COVID-19 (Pfzer-BioNTech) vaccine were included in our observational, multicenter, prospective study. Results: A total of 287 patients (58.2% male;mean age: 47) were included in the study. 202 (%70,4) of patients were being followed up with the diagnosis of AS, 40 (%13,9) of them with PsA, 32 (%11,1) of them with nr-axSpA, 11 (%3,8) of them with enteropathic arthritis, and 2 (%0,7) of them with uSpA. The most common comorbidities were found to be HT (n:65;22.6%) and DM (n:38;13.2%). While 221 (77%) of the patients were receiving biological therapy alone, 27 (9.4%) patients were using methotrexate, 25 (8.7%) patients were using sul-fasalazine, and 12 (4.2%) patients were using lefunomide. The median duration of biological therapy was 40 weeks (19-75 IQR). The most commonly used treatment was infiximab (26.8%), adalimumab (23.3%) was the second (Table 1). It was determined that 207 (72.1%) of the patients preferred inactivated virus vaccine, while 80 (27.9%) preferred mRNA vaccine. When the time between the biological treatment and the day of vaccination is examined, detected median time between biological treatment and the frst dose of vaccination is 11.5 days (5-19 IQR), between the frst dose of vaccination and biological treatment is 14 days (7-21 IQR), between treatment and the second dose of vaccine is 14 days (5-23.5 IQR), and between the second dose of vaccine and the next biological treatment is 12.5 days (7-15 IQR). While 25 (8.7%) of the patients had COVID-19 infection before vaccination, 7 (2.4%) patients were found to have COVID-19 after vaccination (p<0.001). While two of the patients who had COVID-19 infection in the pre-vaccination period required hospitalization, none of the patients who had COVID-19 in the post-vaccination period required hospitalization. The rate of patients who developed side effects after the frst dose of the vaccine was 20.6%. The side effects seen, respectively, were detected as pain-redness at the injection site (16%), fatigue (11.8%), headache (8.4%), muscle-joint pain (7.3%) and fever (5.6%). The rate of patients reporting side effects after the second dose of the vaccine was 17.1%. The incidence of side effects after mRNA vaccine was found to be statistically signifcant compared to inactivated virus vaccine in terms of both doses (p=0.011, p<0.001). Major side effects such as myocarditis, ana-phylaxis-angioedema, myocardial infarction, and thrombosis were not observed in any of the patients included in the study. There was no evidence of disease activation in the median follow-up of 209 days (145-280 IQR) after vaccination. Conclusion: During the follow-up of the patients during the study, no major vaccine-related side effects, post-vaccine disease activation and the need for treatment change were not detected. In order to more accurately evaluate the efficacy of the vaccination program in the patient population using biologic agents, larger-scale studies including unvaccinated individuals are needed.
ABSTRACT
Background: A significant increased risk of COVID-19 related adverse outcomes of the biological or target-directed synthetic DMARDs (b/tsDMARDs) has not yet been reported. For this reason, it is recommended to continue b/ tsDMARD treatments with maximum compliance with pandemic measures. Objectives: The aim of this study was to evaluate the effects of patients using b/tsDMARDs on drug survival and rheumatic disease control during pandemic. Methods: In this study, patients diagnosed with rheumatic disease using b/tsDMARDs and who were followed up during the 12-month period (January 2020-2021) including the onset of the Covid-19 pandemic at Dokuz Eylul University Faculty of Medicine Rheumatology Clinic were evaluated. In the first 3 months of the pandemic (March-June 2020), the patients skipped at least 2 cycles of treatment with the fear of Covid-19 infection except for infection / surgical reasons was considered as a disruption of the drug. The drug retention rates of the patients on b/tsDMARDs treatments during the pandemic process and the factors affecting this situation were evaluated. Results: The rate of disrupting their b/tsDMARDs was higher in patients> 65 years of age, with a diagnosis of RA and who needed to come to the hospital for bDMARD treatment (p=0.007, p=0.015 and p=0.004, respectively). The overall 1-year b/tsDMARD retention rates was found 91%. It was determined that a history of interruption in b/tsDMARD treatments in the first 3 months of the pandemic [OR: 1.28 (CI: 1.042-8.71), p=0.014] and the need to come to the hospital to receive bDMARD [OR: 0.59 (CI: 0.64-13.11), p=0.041] caused unresponsiveness to return to the same bDMARD treatment and a significant increase in the risk of discontinuation of the biologic treatment. Conclusion: We conclude that it is important for patients to continue taking b/ tsDMARD treatments without interruption in the days past abnormal periods such as pandemic conditions and to make sufficient effort for minimum dose of CS and low disease activity by determining patient-based risk.