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Objectives: To evaluate the humoral immune response to the third dose (booster) of vaccine against SARS-CoV-2 in patients with autoimmune rheumatic diseases who were seronegative after a two-dose regimen. Method(s): Observational study. Patients with autoimmune rheumatic diseases who had not achieved seroconversion after a two-dose vaccine schedule against SARS-CoV-2 were included. To assess the humoral immune response, anti-RBD IgG (S protein receptor binding domain) neutralizing antibody titers were determined by ELISA (cutoff titer 200). The determination was made between 30 to 45 days after the third dose. Result(s): From 66 patients who received SARS-CoV-2 vaccination, 18 patients (29.5%) were seronegative after a two-dose schedule. 61% had SLE, 77% had comorbidities (61% with hypertension, p = 0.03). Patients were on treatment: 10 with prednisone (8 with doses greater than 10 mg/d, p = 0.01), 10 with hydroxychloroquine, one with methotrexate, one with leflunomide, four with azathioprine, five with my cophenolatemofetil and five with rituximab (they are the total number of non-responders on biological treatment, p = 0.03). Regarding the primary vaccination regimen, 11 received BBIBP-CorV (p = 0.01), 5 AZD1222, 1 Gam-COVID-Vac and 1 mRNA1273/Gam-COVID-Vac heterologous scheme. Of these 18 non-responders, 14 received a third dose;nine patients (62%) presented anti-RBD IgG detectable. Of the five patients who did not respond to the booster vaccination, three had received BBIBP-CorV as the initial schedule and the vaccines applied as a third dose were Ad5-nCoV (1), BNT162b2 (1), AZD 1222 (2) and Gam-COVID-Vac (1). They were being treated with: rituximab (2), azathioprine (2) and mycophenolate mofetil (1). Treatment with higher doses of prednisone was the only factor associated with non-seroconversion to the third dose (8 +/- 4.5;p 0.02). Conclusion(s): The third dose of SARS-CoV-2 vaccine allowed to improve the serological response to vaccination, achieving a seroconversion of 62% in this group of patients.
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Background: Several trials have reported lower seroconversion rates in patients with autoimmune rheumatic diseases than in healthy patients. In Argentina, the vaccines that were available during the development of this study were: Sputnik V (Gam-COVID-Vac), AstraZeneca (ChAdOx1 nCov-19), Sinopharm (BBIBP-CorV) and Moderna (mRNA-1273). Limited information is available about vaccines against SARS-CoV2 with inactivated virus or viral vector in autoimmune patients. Objectives: To evaluate the humoral immune response to vaccines against SARS-CoV2 in patients with autoimmune rheumatic diseases;to compare the humoral response among patients with Systemic Lupus Erythematosus (SLE) and other autoimmune diseases and to analyse the variables associated. Methods: We included patients with autoimmune rheumatic diseases (Rheumatology Unit of Padilla Hospital, Tucumán, Argentina), who received vaccination against SARS-CoV2 from June 2021. Sociodemographic, comorbidities, related to rheumatic disease, vaccination and SARS-CoV2 infection were the variables recorded. To evaluate the humoral immune response, the neutralizing anti-S-RBD IgG antibody titres were determined by ELISA 'In House' test with a cut-off titre of 200 (IMMCA). The times established for the serological determinations were: T0 or baseline: 1st vaccine dose, T1: 14 ± 2 days after the 1st dose, T2: 2nd dose, T3: 21-45 days after the 2nd dose, T4: 30 days after the 3rd dose, T5: 6 months and T6: 12 months after the 3rd dose. Results: 66 patients were included, 91% women and 92.4% Amerindians. The mean age was 40.7 ± 11.4 years;53% with SLE, 15.2% Rheumatoid Arthritis, 7.6% Systemic Sclerosis, 7.6% Juvenile Idiopathic Arthritis, 7.6% Systemic Vasculitis and 9% other diagnoses;mean disease duration was 12.05 ± 7. 5 years;63.6% had at least one comorbidity (57% HBP, 31% overweight or obesity). At baseline, the treatments received were: corticoster-oids (37.9%, prednisone mean dose 4.12 ± 8 mg/day), cDMARDs (75.7%), bDMARDs (18.2%): Rituximab (58.3%) and anti TNF (25%). Sixteen patients (24.2%) had previous COVID19 (75% mild symptoms). The vaccines applied were: AstraZeneca 38.2%, Sinopharm 31.7%, Sputnik V 19%, and combined schedule Sputnik V/Moderna in 11%. At baseline, 28.8% had detectable anti-S-RBD IgG antibodies. This frequency increased to 48.4% at 1st dose and 70.2% at 2nd dose. The variables that were associated with lower sero-conversion rates and lower antibody titre were vaccination with Sinopharm (p 0.028) and treatment with bDMARDs (p 0.02), none of the 5 patients with Rituximab showed seroconversion. There were no significant differences in the levels of anti-S-RBD IgG antibodies between patients with SLE and the other rheumatic diseases. Patients who had SARS-CoV2 infection prior to vaccination had higher antibody titres in both T1 (p 0.006) and T2 (p 0.002) but after the two doses this difference was not significant (p 0.67). In the regression analysis, the variables that were independently associated with seroconversion were the type of vaccine applied at the 1st dose and the hypertensive disease. The chance of responding to vaccination was 13 and 9 times higher for those who received Sputnik V (OR 12.78;95% CI 1.46-315.9) or AstraZeneca (OR 8.61;95% CI 1.63-72.5) respectively, than Sinopharm in the 1st dose. The chance of being a responder was 88% lower for hypertensive patients (OR 0.12;95% CI 0.02-0.58). Conclusion: In this preliminary analysis, a seroconversion rate of 70.2% was associated with two-dose vaccination for SARS-CoV2 in patients with autoimmune rheumatic diseases. There were no differences in the serological response between patients with SLE and other rheumatic diseases. The humoral immune response was lower in patients with bDMARDs and null in those who received Rituximab. Seroconversion and antibody titres levels were associated with the type of vaccine applied, being Sinopharm who presented the lowest response. The follow-up will provide more knowledge about the behaviour of the humoral response in our patients.
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Background: Persistent symptoms after acute COVID have been described previously. Main symptoms reported are fatigue, arthralgias, myalgias and mental sickness. Defnition and methods vary widely.1 Objectives: To asses prevalence and related factors to long COVID in a retrospective cohort of patients with rheumatic diseases from Argentina. Methods: A total of 1915 patients were registered from August 18th, 2020 to July 29th, 2021. Patients > 18 years old, with rheumatic disease and confrmed infection by SARS-CoV-2 (antigen or RT-PCR) were included. Those dead, with unknown outcome, wrong date or missing data were excluded. Demographic data, comorbidities, rheumatic disease, and characteristics of SARS-CoV-2 infection were recorded. Long COVID was defned according to NICE guidelines (persistent symptoms for more than 4 weeks, without alternative diagnosis). Long COVID symptoms were defned by rheumatologist. Severity of infection was clas-sifed according to WHO ordinal scale. We used descriptive statistics, univariate model (Student's test, chi square test, ANOVA) and multivariate logistic regression analysis. Results: 230 (12%) had long COVID. Median age was 51 (IQR 40-61]) years, 82% were females, 51% were not caucasian. Median of education was 13.3 years (IQR 12-16), 79 % had private health insurance and 55 % were employed. Nearly half (n=762, 46%) had comorbidities, the most prevalent was hypertension (n=396, 24%). The most frequent rheumatic diseases were rheumatoid arthritis (n=719, 42%) and systemic lupus ery-thematosus (n=280, 16 %). Most were in low activity/remission (79%), used Conventional DMARD (n=773 patients, 45%) and steroids (n=588, 34%) at low dose (n=415, 71%). Main laboratory findings were abnormal D-di-mer (n=94, 28%) and leukopenia (n=93, 26%). Most patients had a WHO ordinal scale < 5 (n=1472, 86%). Median of hospitalization at intensive care unit (ICU) was 8 days [IQR 5, 13]. Treatment for SARS-CoV-2 infection (steroids, anticoagulation, azithromycin, convalescent plasma) was used in 461 (27%) patients. Most of long COVID (n= 152, 69%) reported 1 symptom, the most frequent was fatigue (n= 55, 22%). Figure 1. Univariate analysis is presented in Table 1. In multivariate logistic regression analysis non-caucasian ethnicity OR 1.44 (1.07-1.95), years of education OR 1.05 (1-1.09), treatment with cyclophosphamide OR 11.35 (1.56-112.97), symptoms of COVID-19 OR 13.26 (2.75-242.08), severity scale WHO ≥ 5 OR 2.46 (1.68-3.57), and ICU hospitalization days OR 1.09 (1.05-1.14) were factors associated to long COVID. Conclusion: Prevalence of long COVID was 12%. Non-caucasian ethnicity, higher education, treatment with cyclophosphamide, symptoms of COVID-19, severe disease and ICU hospitalization days were related to long COVID.
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Background: Comorbidities, particularly cardio-metabolic disorders, are highly prevalent in patients with psoriatic arthritis (PsA) and they were associated with an increased risk of atherosclerotic cardiovascular disease, which have been associated with higher morbidity and mortality. Whether PsA enhances the risk of SARS-CoV-2 infection or affects the disease outcome remains to be ascertained. Objectives: To describe the sociodemographic, clinical and treatment characteristics of patients with PsA with confrmed SARS-CoV-2 infection from the SAR-COVID registry and to identify the variables associated with poor COVID-19 outcomes, comparing them with those with rheumatoid arthritis (RA). Methods: Cross-sectional observational study including patients ≥18 years old, with diagnosis of PsA (CASPAR criteria) and RA (ACR/EULAR 2010 criteria), who had confrmed SARS-CoV-2 infection (RT-PCR or serology) from the SAR-COVID registry. Recruitment period was between August 13, 2020 and July 31, 2021. Sociodemographic variables, comorbidities, and treatments were analyzed. To assess the severity of the infection, the ordinal scale of the National Institute of Allergy and Infectious Diseases (NIAID)1 was used, and it was considered that a patient met the primary outcome, if they presented criteria of categories 5 or higher on the severity scale. For this analysis, Chi2 test, Fisher's test, Student's test or Wilcoxon test, and binomial logistic regression using NIAID>=5 as dependent variable were performed. Results: A total of 129 PsA patients and 808 with RA were included. Clinical characteristics are shown in Table 1. Regarding PsA treatment, 12.4% of PsA were receiving IL-17 inhibitors, 5.4% IL12-23 inhibitors, one patient apremilast and one abatacept. The frequency of NIAID≥5 was comparable between groups (PsA 19.5% vs RA 20.1%;p=0.976). (Figure 1). PsA patients with NIAID≥5 in comparison with NIAID<5 were older (58.6±11.4 vs 50±12.5;p=0.002), had more frequently hypertension (52.2% vs 23%;p=0.011) and dyslipidemia (39.1% vs 15%;p=0.017). In the multivariate analysis, age (OR 1.06;95% CI 1.02-1.11) was associated with a worse outcome of the COVID-19 (NIAID≥5) in patients with PsA, while those who received methotrexate (OR 0.34;95% CI 0.11-0.92) and biological DMARDs (OR 0.28;95% CI 0.09-0.78) had a better outcome. Conclusion: Although PsA patients have a higher frequency of cardiovascular and metabolic comorbidities than those with RA, the COVID-19 severity was similar. Most of the patients had mild SARS-CoV-2 infection and a low death rate.