Characteristics of and risk factors for COVID-19 breakthrough infections in idiopathic inflammatory myopathies: results from the COVAD study

Hoff LS 1 , Ravichandran N 2 , Sen P 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 , Tehozol EAZ 27 , Serrano JR 28 , Torre IG 29 , Colunga-Pedraza IJ 30 , Merayo-Chalico J 31 , Chibuzo OC 32 , Katchamart W 33 , Goo PA 34 , Shumnalieva R 35 , El Kibbi L 36 , Halabi H 37 , Vaidya B 38 , Shaharir SS 39 , Hasan ATMT 40 , Dey D 41 , Gutiérrez CET 42 , Caballero-Uribe CV 43 , Lilleker JB 44 , Salim B 45 , Gheita T 46 , Chatterjee T 47 , Distler O 48 , Saavedra MA 49 , Chinoy H 44 , Agarwal V 2 , Aggarwal R 50 , Gupta L 51 , COVAD Study Group

Affiliations 

  • 1 Department of Medicine, School of Medicine, Universidade Potiguar (UnP), Natal, Brazil
  • 2 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 3 Maulana Azad Medical College, New Delhi, Delhi, India
  • 4 Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia
  • 5 Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
  • 6 Department of Rheumatology, 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 in Szczecin, 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, Deutschland
  • 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, 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 Campus, 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 Rheumatology Unit, Internal Medicine Department, Specialized Medical Center, Riyadh, Saudi Arabia
  • 37 Department of Internal Medicine, Section of Rheumatology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
  • 38 National Center for Rheumatic Diseases (NCRD), Ratopul, Kathmandu, Nepal
  • 39 Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
  • 40 Department of Rheumatology, Enam Medical College & Hospital, Dhaka, Bangladesh
  • 41 Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
  • 42 General Director, Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali, Valle del Cauca, Colombia
  • 43 Department of Medicine, Hospital Universidad del Norte, Barranquilla, Atlantico, Colombia
  • 44 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
  • 45 Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
  • 46 Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
  • 47 Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Illinois, USA
  • 48 Department of Rheumatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
  • 49 Departamento de Reumatología, Hospital de Especialidades Dr Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico
  • 50 Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  • 51 Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
Rheumatology (Oxford), 2025 Feb 01;64(2):597-606.
PMID: 38430474 DOI: 10.1093/rheumatology/keae128

Abstract

OBJECTIVES: The objective of this study was to explore the prevalence, characteristics and risk factors of COVID-19 breakthrough infections (BIs) in idiopathic inflammatory myopathies (IIMs) using data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

METHODS: A validated patient self-reporting e-survey was circulated by the COVAD study group to collect data on COVID-19 infection and vaccination in 2022. BIs were defined as COVID-19 occurring ≥14 days after two vaccine doses. We compared BI characteristics and severity among patients with IIMs, patients with other autoimmune rheumatic and non-rheumatic diseases (AIRD, nrAID), and healthy controls (HCs). Multivariable Cox regression models were used to assess the risk factors for BI, severe BI ,and hospitalizations among patients with IIMs.

RESULTS: Among the 9449 included responses, BIs occurred in 1447 respondents (15.3%). The median age was 44 years [interquartile range (IQR) 21], 77.4% were female, and 182 BIs (12.9%) occurred among the 1406 patients with IIMs. Multivariable Cox regression among the data for patients with IIMs showed increasing age to be a protective factor for BIs [hazard ratio (HR) = 0.98, 95% CI = 0.97-0.99], and HCQ and SSZ use were risk factors (HR = 1.81, 95% CI = 1.24-2.64, and HR = 3.79, 95% CI = 1.69-8.42, respectively). Glucocorticoid use was a risk factor for a severe BI (HR = 3.61, 95% CI = 1.09-11.8). Non-white ethnicity (HR = 2.61, 95% CI = 1.03-6.59) was a risk factor for hospitalization. Compared with other groups, patients with IIMs required more supplemental oxygen therapy (IIMs = 6.0% vs AIRDs = 1.8%, nrAIDs = 2.2% and HCs = 0.9%), intensive care unit admission (IIMs = 2.2% vs AIRDs = 0.6%, nrAIDs and HCs = 0%), advanced treatment with antiviral or monoclonal antibodies (IIMs = 34.1% vs AIRDs = 25.8%, nrAIDs = 14.6% and HCs = 12.8%) and had more hospitalization (IIMs = 7.7% vs AIRDs = 4.6%, nrAIDs = 1.1% and HCs = 1.5%).

CONCLUSION: Patients with IIMs are susceptible to severe COVID-19 BIs. Age and immunosuppressive treatments were related to the risk of BIs.

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

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