Flares in IIMs and the timeline following COVID-19 vaccination: a combined analysis of the COVAD-1 and -2 surveys

• Published in: Rheumatology (Oxford, England) England), 2024-01, Vol.63 (1), p.127-139
• Main Authors: R, Naveen, Sen, Parikshit, Griger, Zoltán, Day, Jessica, Joshi, Mrudula, Nune, Arvind, Nikiphorou, Elena, Saha, Sreoshy, Tan, Ai Lyn, Shinjo, Samuel Katsuyuki, Ziade, Nelly, Velikova, Tsvetelina, Milchert, Marcin, Jagtap, Kshitij, Parodis, Ioannis, Gracia-Ramos, Abraham Edgar, Cavagna, Lorenzo, Kuwana, Masataka, Knitza, Johannes, Chen, Yi Ming, Makol, Ashima, Agarwal, Vishwesh, Patel, Aarat, Pauling, John D, Wincup, Chris, Barman, Bhupen, Zamora Tehozol, Erick Adrian, Rojas Serrano, Jorge, García-De La Torre, Ignacio, Colunga-Pedraza, Iris J, Merayo-Chalico, Javier, Chibuzo, Okwara Celestine, Katchamart, Wanruchada, Akarawatcharangura Goo, Phonpen, Shumnalieva, Russka, Hoff, Leonardo Santos, El Kibbi, Lina, Halabi, Hussein, Vaidya, Binit, Shaharir, Syahrul Sazliyana, Hasan, A T M Tanveer, Dey, Dzifa, Toro Gutiérrez, Carlos Enrique, Caballero-Uribe, Carlo V, Lilleker, James B, Salim, Babur, Gheita, Tamer, Chatterjee, Tulika, Distler, Oliver, Saavedra, Miguel A, Chinoy, Hector, Agarwal, Vikas, Aggarwal, Rohit, Gupta, Latika
• Format: Article
• Language: English
• Subjects: Autoimmune Diseases - physiopathology; COVID-19 - prevention & control; COVID-19 Vaccines; COVID-19 Vaccines - adverse effects; Disease Exacerbation; Disease Progression; Female; Humans; Idiopathic Inflammatory Myopathies; Male; Medicin och hälsovetenskap; Middle Aged; Myositis - physiopathology; Patient Reported Outcomes; Rheumatic Diseases - physiopathology; Surveys and Questionnaires; Vaccination - adverse effects
• ISSN: 1462-0324; 1462-0332; 1462-0332
• DOI: 10.1093/rheumatology/kead180

Disease flares in the post-coronavirus disease 2019 (COVID-19) vaccination period represent a prominent concern, though risk factors are poorly understood. We studied these flares among patients with idiopathic inflammatory myopathies (IIMs) and other autoimmune rheumatic diseases (AIRDs). The COVAD-1 and -2 global surveys were circulated in early 2021 and 2022, respectively, and we captured demographics, comorbidities, AIRDs details, COVID-19 infection history and vaccination details. Flares of IIMs were defined as (a) patient self-reported, (b) immunosuppression (IS) denoted, (c) clinical sign directed and (d) with >7.9-point minimal clinically significant improvement difference worsening of Patient-Reported Outcomes Measurement Information System (PROMIS) PROMISPF10a score. Risk factors of flares were analysed using regression models. Of 15 165 total respondents, 1278 IIMs (age 63 years, 70.3% female, 80.8% Caucasians) and 3453 AIRDs were included. Flares of IIM were seen in 9.6%, 12.7%, 8.7% and 19.6% patients by definitions (a) to (d), respectively, with a median time to flare of 71.5 (10.7-235) days, similar to AIRDs. Patients with active IIMs pre-vaccination (OR 1.2; 95% CI 1.03, 1.6, P = 0.025) were prone to flares, while those receiving rituximab (OR 0.3; 95% CI 0.1, 0.7, P = 0.010) and AZA (OR 0.3, 95% CI 0.1, 0.8, P = 0.016) were at lower risk. Female gender and comorbidities predisposed to flares requiring changes in IS. Asthma (OR 1.62; 95% CI 1.05, 2.50, P = 0.028) and higher pain visual analogue score (OR 1.19; 95% CI 1.11, 1.27, P