COVID-19 severity and vaccine breakthrough infections in idiopathic inflammatory myopathies, other systemic autoimmune and inflammatory diseases, and healthy controls: a multicenter cross-sectional study from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) survey

• Published in: Rheumatology international 2023-01, Vol.43 (1), p.47-58
• Main Authors: Hoff, Leonardo Santos, Ravichandran, Naveen, Shinjo, Samuel Katsuyuki, Day, Jessica, Sen, Parikshit, Junior, Jucier Gonçalves, Lilleker, James B., Joshi, Mrudula, Agarwal, Vishwesh, Kardes, Sinan, Kim, Minchul, Milchert, Marcin, Makol, Ashima, Gheita, Tamer, Salim, Babur, Velikova, Tsvetelina, Gracia-Ramos, Abraham Edgar, Parodis, Ioannis, O’Callaghan, Albert Selva, Nikiphorou, Elena, Tan, Ai Lyn, Chatterjee, Tulika, Cavagna, Lorenzo, Saavedra, Miguel A., Ziade, Nelly, Knitza, Johannes, Kuwana, Masataka, Nune, Arvind, Distler, Oliver, Cansu, Döndü Üsküdar, Traboco, Lisa, Wibowo, Suryo Angorro Kusumo, Tehozol, Erick Adrian Zamora, Serrano, Jorge Rojas, La Torre, Ignacio García-De, Wincup, Chris, Pauling, John D., Chinoy, Hector, Agarwal, Vikas, Aggarwal, Rohit, Gupta, Latika
• Format: Article
• Language: English
• Subjects: Adult; Animals; Autoimmune diseases; Autoimmune Diseases - epidemiology; Breakthrough infection; Breakthrough Infections; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 Vaccines; Cross-Sectional Studies; Female; Hospitalization; Humans; Idiopathic inflammatory myopathies; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Infections; Inflammatory diseases; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Myositis; Observational Research; Regression analysis; Rheumatology; SARS-CoV-2 vaccination; Self Report; Simian Acquired Immunodeficiency Syndrome; Vaccination
• ISSN: 1437-160X; 0172-8172; 1437-160X
• DOI: 10.1007/s00296-022-05229-7

Objectives We aimed to compare the spectrum and severity of COVID-19 and vaccine breakthrough infections (BIs) among patients with IIMs, other systemic autoimmune and inflammatory diseases (SAIDs), and healthy controls (HCs). Methods This is a cross-sectional study with data from the COVAD study, a self-reported online global survey that collected demographics, COVID-19 history, and vaccination details from April to September 2021. Adult patients with at least one COVID-19 vaccine dose were included. BIs were defined as infections occurring > 2 weeks after any dose of vaccine. Characteristics associated with BI were analyzed with a multivariate regression analysis. Results Among 10,900 respondents [42 (30–55) years, 74%-females, 45%-Caucasians] HCs were (47%), SAIDs (42%) and IIMs (11%). Patients with IIMs reported fewer COVID-19 cases before vaccination (6.2%-IIM vs 10.5%-SAIDs vs 14.6%-HC; OR = 0.6, 95% CI 0.4–0.8, and OR = 0.3, 95% CI 0.2–0.5, respectively). BIs were uncommon (1.4%-IIM; 1.9%-SAIDs; 3.2%-HC) and occurred in 17 IIM patients, 13 of whom were on immunosuppressants, and 3(18%) required hospitalization. All-cause hospitalization was higher in patients with IIM compared to HCs [23 (30%) vs 59 (8%), OR = 2.5, 95% CI 1.2–5.1 before vaccination, and 3 (18%) vs 9 (5%), OR = 2.6, 95% CI 1.3–5.3 in BI]. In a multivariate regression analysis, age 30–60 years was associated with a lower odds of BI (OR = 0.7, 95% CI 0.5–1.0), while the use of immunosuppressants had a higher odds of BI (OR = 1.6, 95% CI 1.1–2.7). Conclusions Patients with IIMs reported fewer COVID-19 cases than HCs and other SAIDs, but had higher odds of all-cause hospitalization from COVID-19 than HCs. BIs were associated with the use of immunosuppressants and were uncommon in IIMs.