ABSTRACT
BackgroundData on cellular and humoral immunogenicity triggered by SARS-CoV-2 vaccines in patients with autoimmune rheumatic diseases (ARDs) are limited. While current vaccine efforts have focused on the induction of neutralizing antibodies against SARS-CoV-2, T-cell immunity may also provide protection against infection. Experimental data suggest that CD8+ T cell responses may have a protective role in the presence of decreasing or sub protective antibody titers [1].ObjectivesThe aim of this project is to describe the serological and T cell responses to the third dose of vaccine (either with BNT162b2 mRNA or ChAdOx1 nCoV-19 replication-deficient adenoviral vector vaccines) in a cohort of patients with ARDs (rheumatoid arthritis and spondyloarthropathies) treated with biologic therapies, to describe the impact of these treatments on vaccine response in this patient population. As a second objective, we will describe the characteristics of patients who did not present an adequate immunogenic response.MethodsCase-control study. We studied in 79 patients with ARDs and in 31 healthy controls, anti-SARS-CoV-2 specific interferon-gamma (IFN-γ) production measured by IGRA between 8-12 weeks after the third dose of anti-SARS-CoV-2 vaccine. In addition, humoral response was measured by anti-S1 IgG antibody production measured by chemiluminescent microparticle immunoassay. Statistical comparison between categorical variables was performed by Fisher's or χ2 test. For quantitative variables by Kruskal-Wallis test or Mann-Whitney test.Results79 patients with ARDs (48 women, 31 men;mean age 58±11.4) 43 (54%), with rheumatoid arthritis and 36 (45.6%) with spondyloarthropathies. 32 (49.5%) of them were on glucocorticoid treatment (mean dose 4.92 mg/day), 25 (31.6%) on methotrexate and 56 (70.9%) on anti-TNF. Post-vaccination results showed positive T-cell immune responses in 68 of 79 (86.1%) ARDs patients with mean IFN- γ anti-SARS-CoV-2 titers of 1,606.85 mUI/ml. 7 (8.9%) of ARDs patients showed negative IFN-γ SARS-CoV-2 levels, while 4 (5%) had borderline titers. 100% of patients with previous COVID 19 disease had positive cellular responses. Within the group of negative or borderline cellular responses, 7 of 10 were men (70%), with no significant differences in terms of diagnosis, comorbidities or immunosuppressive treatments used. In the control group, 100% presented positive cellular responses. Anti-Spike IgG antibodies were detectable in all patients with ARDs as in the control group.ConclusionOur preliminary data show that most patients with ARD were able to generate an adequate specific cellular response after vaccination against SARS-CoV-2, emphasizing the relevance of vaccination in this group. Specific antibody responses secondary to anti-SARS-CoV-2 vaccination were detected in all patients with ARD. Our data could support the relevance of these immune responses to personalize prevention, vaccination decision-making and treatment in this subgroup of patients.References[1]Sieiro Santos C, Calleja Antolin S, Moriano Morales C, Garcia Herrero J, Diez Alvarez E, Ramos Ortega F, et al. Immune responses to mRNA vaccines against SARS-CoV-2 in patients with immune-mediated inflammatory rheumatic diseases. RMD Open. 2022 Jan 5;8(1).Figure 1.Specific anti-SARS-CoV-2-IFN- γ responses measured by IGRA. Dotted lines represent positivity cut-off: ≥200mUI/ml. HC: Healthy controls. AIRDs: Autoimmune rheumatic diseases.[Figure omitted. See PDF]Acknowledgements:NIL.Disclosure of InterestsNone Declared.
ABSTRACT
Background: The COVID-19 pandemic continues worldwide and has had a strong impact on public health. As the pandemic evolves, efforts have been inten-sifed to identify persistent symptoms associated with the infection once resolved have intensifed. Objectives: We aimed to describe persistent symptoms and sequelae in patients with rheumatic and musculoskeletal diseases (RMD) after admission due to Covid-19. We also compared the role of autoimmune rheumatic diseases (ARD) with that of non-autoimmune rheumatic and musculoskeletal diseases (NARD) in persistent symptoms and sequelae. Methods: We performed an observational study of patients with RMD who attended a rheumatology outpatient clinic in Madrid and required admission to hospital due to Covid-19 (1st March-30th May 2020) and survived. The study began at discharge and ran until 1st October 2020. The main outcomes were persistence of symptoms and sequelae related to Covid19. The independent variable was the RMD group (ARD and NARD). The covariates were sociode-mographic data, clinical fndings, and treatment. We ran a multivariate logistic regression model to assess the risk of the main outcomes by RMD group. Results: We included 105 patients, of whom 51.5% had ARD and 68.57% reported at least 1 persistent symptom. The most frequent were dyspnea, fatigue, and chest pain. Sequelae were recorded in 31 patients. These included lung damage in 10.4% of patients, lymphopenia in 10%, central retinal vein occlusion (1 patient), and optic neuritis (1 patient). Two patients died. Eleven patients required readmission owing to Covid-19 problems (16.7% ARD vs 3.9% NARD;p=0.053). No statistically signifcant differences were found between RMD groups in the fnal models. Conclusion: Many RMD patients have persistent symptoms, as in other populations. Lung damage is the most frequent sequela. Compared to NARD patients, ARD patients do not seem to differ in terms of persistent symptoms or sequelae, although ARD patients might generate more readmissions due to Covid-19.
ABSTRACT
Background: Spain has been one of the countries most impacted by the COVID-19 pandemic. Among Spanish patients, 56,799 deaths have been reported. Although we have been in this situation of pandemic for a year, studies that show risk mortality rates in patients with rheumatic diseases continue to be scarce. Objectives: In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid -19, a) we want to assess the mortality rate (MR) related to COVID-19;and b) to analyze the role of RMDs in mortality risk. Methods: An observational longitudinal study was conducted during the epidemic peak in Madrid (1stMar to 20thMay2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and SARS -CoV 2 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main outcome: death related to COVID-19 infection. Independent variable: type of RMDs including: autoimmune (systemic autoimmune conditions (SAC) and inflammatory joint disease (IJD)) and non-autoimmune (mechanical diseases and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, comorbidities, chronic use of corticoids prior to COVID-19 infection. Survival techniques were used to estimate the MR related to COVID-19, given per 1,000 persons-month with a 95% confidence interval [CI]. The time of observation comprised the elapsed time between the date of COVID-19 diagnosis of infection until the date of patient's death, or end of study. Cox multiple regression analysis was run to examine the effect of autoimmune RMDs compared to non-autoimmune RMDs on mortality risk adjusted by sex, age and comorbidities. Results were expressed by Hazard Ratio (HR) and [CI]. Results: 406 patients were included with RMD and Covid -19 infection with a total follow-up 642.5 patients-month. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of rheumatic disease was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic condition) had autoimmune RMD. Of the 406 patients, 45 (11%) died during the follow-up, being 12± 14 days the mean time from infection to death (P50: 6[2-12] and a maximum of 60 days). MR was estimated in 70.03 [52.28-93.79] per 1,000 persons-month. MR was higher for men (MR 105[68-163]) than for women (MR 55 [37.2-81.6]) and in older people (MR <60: 4.4, [0.6-31.7];MR 60-75 years: 38.7[17.3-86.2];MR ≥75Years: 486 [354-1668]). The HR of mortality in autoimmune RMDs compared to non-autoimmune RMDs did not achieved statistical significance (HR: 1.39 [0.77-2.5], p=0.27). After adjusting for confounders, we did not find higher risk of mortality among the different types of RMDs (HR autoimmune vs non-autoinmunes: HR: 1.12 [0.6-2.02], p=0.7;HR IJD vs SAC;1.5 [0.6-3.6], p=0.34;HR non-autoimmune vs SAC: 1.1 [0.5-2.5], P=0.7). Age (HR: 1.12;[1.10-1.15], p<0.001), and the presence of comorbidities (HR: 2.05;[1.08-3.89], p=0.027) increased the Mortality risk. Conclusion: In patients with RMD and COVID-19 infection, we found a mortality rate of 7 per 100 persons-month. This study shows that the mortality risk related to COVID-19 is similar between autoimmune and non-autoimmune diseases after adjusting by confounders. We also found that age and comorbidities are risk factors for mortality related to COVID-19 infection.
ABSTRACT
Background: The COVID-19 pandemic continues worldwide and has had a strong impact on public health, quality of life and economy of the general population. To date, the number of infections and deaths are still increasing. From the beginning of the pandemic, efforts were intensified to identify risk factors for development of the severe form of COVID-19. In this sense underlying medical comorbidities have been shown to have a worse prognosis in these patients. Objectives: In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid -19, we aim to investigate the role of systemic autoimmune conditions compared to other type of RMDs in severity of COVID-19 in terms of hospital admissions. Methods: An observational longitudinal study was conducted during the epidemic peak in Madrid (1stMar to 20thMay2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and COVID-19 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main variable: hospital admission related to Covid -19 infection. Independent variable: type of RMD including: autoimmune (systemic autoimmune conditions and inflammatory joint disease (IJD)) and nonautoimmune (mechanical diseases, and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, clinical and therapy used. Statistical analysis: description of the sociodemographic, clinical and treatment characteristics of the patients. A multivariate logistic regression adjusted by age, sex and comorbidities was used to evaluate the risk of the different types of RMDs in hospital admissions related to Covid-19. The results were expressed as OR with its corresponding confidence interval (95% CI). Results: 406 patients were included with RMDs and Covid-19 infection. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of RMD was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic autoimmune condition) had autoimmune RMD. 36% of all patients were admitted (31% from not autoimmune RMDs and 43% from autoimmune RMD (p = 0,013). The risk of hospital admission in autoimmune RMD compared to non-autoimmune RMD was higher (OR: 1.68;[1.11-2.54], p=0.013), being the risk of systemic autoimmune condition compared to both IJD and non-autoimmune RMD higher (OR IJD: 0.41 [0.21-0.51], p=0.01;OR non-autoimmune: 0.33;[0.18-0.61];p=0.000). After adjusting by confounders, autoimmune RMD had higher risk of hospital admissions compared to the rest (OR: 1.75;[1.04-2.95];p=0.03), and specifically systemic autoimmune condition had higher risk compared to IJD (OR of IJD 0.33;[0.14-.076];p=0.009) and compared to non-autoimmune (OR non autoimmune 0.28;[0.13-0.59], p=0.001). Advanced age (OR: 1.10;[1.07-1.12], p<0.001), male (OR 0.58;[0.33-1.02], p=0.06), and more number of comorbidities (OR 1.39;[1.02-1.90] p=0.03) also increased the risk of hospitalization related to COVID-19. Conclusion: One third of the RMD patients infected with COVID-19 required hospital admission. This study shows that patients with autoimmune and specifically with systemic autoimmune conditions have a higher risk of hospitalization related to COVID-19. We also show that advanced age, male sex and a higher number of comorbidities can contribute to worsen the prognosis of the COVID-19 disease.