ABSTRACT
Background: Having an autoimmune disease was an exclusion criterion in the efficacy and safety phase studies of vaccines against Covid-19 (1-2). In Turkey vaccination frst started with the inactivated CoronaVac, then with the mRNA BNT162b2 vaccine. Although there are studies on vaccine efficacy and safety in adults with infammatory rheumatic disease (IRD), there are still many unknowns (3-4). Objectives: Primary outcome of this study is to determine the seroconversion (SC) rate after CoronaVac and BNT162b2 vaccines in adults with IRD and to compare it with a healthy control group. Secondary outcomes are to evaluate whether there are efficacy differences in the two vaccine types, and to investigate the effects of the biologic agent used in the patient group on the vaccine immunogenicity. Methods: This prospective observational single center study was conducted at the Gazi University Hospital. Patients who were followed up in our outpatient clinic with IRD and who received two doses of either CoronaVac or BNT162b2 vaccines were included. Subjects with two doses one of these vaccine without IRD were included in the healthy control group. Patients who had Covid-19 infection before or during vaccination were excluded. The demographic characters were recorded. The interval between the two doses was 4 weeks. The blood samples of the patient and control groups were taken a minimum of two and a maximum of 12 weeks after the second dose. Anti-S antibodies against SARS-CoV-2 spike proteins were evaluated with the IgG Abbott kit, and a value above 50 arbitrary unit/ml was considered as positive SC. The neutralizing antibody titers were evaluated with the DIA.PRO kit, and cut-off value was above 1 Co/S. Results: The SC rate was slightly lower among patients with IRD versus controls (84% vs 97%, p:0.002). The SC rate was 100% in all participants who received BNT162b2 both in the patient and control group. The IgG antibody level after CoronaVac was signifcantly lower than that of BNT162b2 vaccine (p:0.031) in both patient and healthy controls (p:0.001). Among patients with IRD, those on rituximab (RTX)(12/81, %14.8) had signifcantly less SC rate (5/12, 41.7%) compared to patients on other biologicals (63/69, 91.3%) (p<0.001). Conclusion: This study showed that all patients with BNT162b2 vaccine developed immunogenicity in patients with IRD, while there was a decreased antibody response with CoronaVac vaccine compared to the healthy control group. In particular, the use of RTX signifcantly reduces the SC rate.
ABSTRACT
Post-coronavirus disease (COVID) syndrome (PCS) is a term used to describe the clinical condition of patients who have recovered from COVID-19 but are still experiencing prolonged effects of infection or persistent symptoms for longer than expected. Although PCS has been previously studied in the general population, it has not been investigated in a specific population of patients with inflammatory rheumatic disease (IRD). This study aims to evaluate the presence and frequency of PCS among our rheumatology outpatients. This is a cross-sectional study of patients with IRD whose symptoms persisted for 12 weeks after the detection of COVID-19 infection. The patients were assessed with a survey form during their routine clinic follow-up or by contacting them by phone. Patients' demographics, diagnosis, medication, comorbidities, outcome of COVID-19, and symptoms related to PCS were collected. Fifty-three patients with IRD and COVID (mean age: 48.5 13.99 years, 71.7% women) were included. PCS was observed in 36 (67.9%) patients. Twenty-two (41.5%) of them had three or more symptoms; 14 (26.4%) had one or two symptoms. Although more than 30 symptoms were detected, the most frequent were fatigue and weakness. No significant relationship was detected between the development of PCS and gender, age, disease duration, presence of COVID-related complications, and the need for oxygen support, except for smoking which showed a protective effect (p=0.008). PCS was detected in more than half of the patients. There was no independent risk factor for the development of PCS, except smoking.