Flares in IIMs and the timeline following COVID-19 vaccination: a combined analysis of the COVAD-1 and -2 surveys
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All Authors
R,Naveen
Sen,Parikshit
Griger,Zolt醤
Day,Jessica
Joshi,Mrudula
Nune,Arvind
Nikiphorou,Elena
Saha,Sreoshy
Tan,Ai Lyn
Shinjo,Samuel Katsuyuki
LTHT Author
Tan, Ai Lyn
LTHT Department
NIHR Leeds Biomedical Research Centre
Non Medic
Publication Date
2024
Item Type
Article
Language
Subject
Subject Headings
Abstract
Objectives Disease flares in the post朿oronavirus 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). Methods 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. Results 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�5) 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 ?<?0.001) were associated with disparity between self-reported and IS-denoted flares. Conclusion A diagnosis of IIMs confers an equal risk of flares in the post朇OVID-19 vaccination period to AIRDs, with active disease, female gender and comorbidities conferring a higher risk. Disparity between patient- and physician-reported outcomes represents a future avenue for exploration.
Journal
Rheumatology