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

R N 1 , Sen P 2 , Griger Z 3 , Day J 4 , Joshi M 5 , Nune A 6 Show all authors , Nikiphorou E 7 , Saha S 8 , Tan AL 9 , Shinjo SK 10 , Ziade N 11 , Velikova T 12 , Milchert M 13 , Jagtap K 14 , Parodis I 15 , Gracia-Ramos AE 16 , Cavagna L 17 , Kuwana M 18 , Knitza J 19 , Chen YM 20 , Makol A 21 , Agarwal V 22 , Patel A 23 , Pauling JD 24 , Wincup C 25 , Barman B 26 , Zamora Tehozol EA 27 , Rojas Serrano J 28 , García-De La Torre I 29 , Colunga-Pedraza IJ 30 , Merayo-Chalico J 31 , Chibuzo OC 32 , Katchamart W 33 , Akarawatcharangura Goo P 34 , Shumnalieva R 35 , Hoff LS 36 , El Kibbi L 37 , Halabi H 38 , Vaidya B 39 , Shaharir SS 40 , Hasan ATMT 41 , Dey D 42 , Toro Gutiérrez CE 43 , Caballero-Uribe CV 44 , Lilleker JB 45 , Salim B 46 , Gheita T 47 , Chatterjee T 48 , Distler O 49 , Saavedra MA 50 , Chinoy H 45 , Agarwal V 1 , Aggarwal R 51 , Gupta L 45 , COVAD Study Group

Affiliations 

  • 1 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 2 Maulana Azad Medical College, New Delhi, Delhi, India
  • 3 Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
  • 4 Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia
  • 5 Byramjee Jeejeebhoy Government Medical College, and Sassoon General Hospitals, Pune, India
  • 6 Southport and Ormskirk Hospital NHS Trust, Southport, UK
  • 7 Centre for Rheumatic Diseases, King's College London, London, UK
  • 8 Mymensingh Medical College, Mymensingh, Bangladesh
  • 9 NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
  • 10 Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
  • 11 Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
  • 12 Medical Faculty, Sofia University St Kliment Ohridski, Sofia, Bulgaria
  • 13 Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University, Szczecin, Poland
  • 14 Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, Maharashtra, India
  • 15 Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
  • 16 Department of Internal Medicine, General Hospital, National Medical Center, "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
  • 17 Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Lombardy, Italy
  • 18 Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
  • 19 Medizinische Klinik 3-Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
  • 20 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
  • 21 Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
  • 22 Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
  • 23 Bon Secours Rheumatology Center, and Division of Pediatric Rheumatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
  • 24 Bristol Medical School Translational Health Sciences, University of Bristol, UK
  • 25 Department of Rheumatology, Division of Medicine, Rayne Institute, University College London, London, UK
  • 26 Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
  • 27 Rheumatology, Medical Care & Research, Centro Medico Pensiones Hospital, Instituto Mexicano del Seguro Social Delegación Yucatán, Yucatán, Mexico
  • 28 Rheumatologist and Clinical Investigator, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
  • 29 Departamento de Inmunología y Reumatología, Hospital General de Occidente and Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
  • 30 Rheumatology, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico
  • 31 Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  • 32 Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla/University of Nigeria, Enugu, Nigeria
  • 33 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 34 Department of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
  • 35 Department of Rheumatology, Clinic of Rheumatology, University Hospital "St Ivan Rilski", Medical University-Sofia, Sofia, Bulgaria
  • 36 School of Medicine, Universidade Potiguar (UnP), Natal, Brazil
  • 37 Rheumatology Unit, Internal Medicine Department, Specialized Medical Center, Riyadh, Saudi Arabia
  • 38 Department of Internal Medicine, Section of rheumatology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
  • 39 National Center for Rheumatic Diseases (NCRD), Ratopul, Kathmandu, Nepal
  • 40 Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 41 Department of Rheumatology, Enam Medical College & Hospital, Dhaka, Bangladesh
  • 42 Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
  • 43 General Director, Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali, Cali, Colombia
  • 44 Department of Medicine, Hospital Universidad del Norte, Barranquilla, Atlantico, Colombia
  • 45 Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
  • 46 Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
  • 47 Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
  • 48 Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
  • 49 Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
  • 50 Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret IMSS, Centro Médico Nacional La Raza, Mexico City, Mexico
  • 51 Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Rheumatology (Oxford), 2024 Jan 04;63(1):127-139.
PMID: 37084267 DOI: 10.1093/rheumatology/kead180

Abstract

OBJECTIVES: 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).

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 (10.7-235) 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 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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