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Article ; Online: Withholding methotrexate after COVID-19 vaccination: different strategies, same results? - Author's reply.

Mehta, Pankti / Ahmed, Sakir / Shenoy, Padmanabha / Skaria, Teny Grace / Paul, Aby

The Lancet. Rheumatology

2022 Volume 4, Issue 12, Page(s) e817–e818

Language	English
Publishing date	2022-11-24
Publishing country	England
Document type	Journal Article
ISSN	2665-9913
ISSN (online)	2665-9913
DOI	10.1016/S2665-9913(22)00335-6
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Article: Boosting Vaccine Response in Autoimmune Rheumatic Disease Patients With Inadequate Seroconversion: An Analysis of the Immunogenicity of Vector-Based and Inactivated Vaccines.

Vijayan, Anuroopa / Sukumaran, Aswathy / Jones, Sara / Paul, Aby / Ahmed, Sakir / Mehta, Pankti / Mohanan, Manju / Kumar, Santhosh / Easwaran, Sreekumar / Shenoy, Padmanabha

Cureus

2024 Volume 16, Issue 3, Page(s) e55764

Abstract: Background: An additional dose of COVID-19 vaccine is being offered to vaccinated people, especially those immunocompromised. The most widely available vaccines in India are the adenoviral vector-based AZD1222 (ChAdOx1 nCoV-19) and the heat-inactivated ( ...

Abstract	Background: An additional dose of COVID-19 vaccine is being offered to vaccinated people, especially those immunocompromised. The most widely available vaccines in India are the adenoviral vector-based AZD1222 (ChAdOx1 nCoV-19) and the heat-inactivated (BBV152). This study investigated the efficacy of both vaccines in patients with autoimmune rheumatic diseases (AIRD). Objectives: To compare final anti-SARS-CoV-2 antibody titers, neutralization of pseudovirions by these antibodies, and T cell responses between patients of AIRD who had received the third dose of AZD1222 and BBV152 vaccines. Methods: Patients with stable AIRD who had completed two doses of COVID-19 vaccination but had a suboptimal response (anti-receptor binding domain (RBD) antibody<212) were randomized (1:1) to receive either AZD1222 or BBV152 as a booster dose. Patients with previous hybrid immunity or those who developed COVID-19 during the trial were excluded. Antibody titers, neutralization of Wuhan and Omicron pseudovirions, and interferon release by T cells (enzyme-linked immunosorbent spot (ELISpot)) in response to the Spike antigen were measured four weeks after this booster dose. Results: 146 were screened, 91 were randomized, and 67 were analyzed per protocol. The third dose improved antibody titers (p<0.001), neutralization of the Wuhan strain (p<0.001), and T cell interferon release (p<0.001) but not neutralization of the Omicron strain (p=0.24). Antibody titers were higher (p<0.005) after ADZ1222 boost (2,414 IU (interquartile range (IQR): 330-10,315)) than BBV1222 (347.7 IU (0.4-973)). Neutralization of the Wuhan stain was better (AZD1222: 76.6%(23.0-95.45) versus BBV152 (32.7% (0-78.9), p=0.03 by ANCOVA). Neutralization of Omicron (0 (0-28.4) vs 0 (0-4.8)) and T cell interferon release (57.0 IU (23.5-95) vs 50.5 IU (13.2-139)) were similar. Conclusion: The third dose improved all parameters of immunogenicity in AIRD patients with previous inadequate responses except Omicron neutralization. The vector-based vaccine exhibits notable efficacy, particularly in antibody titers and neutralizing the Wuhan strain. Trial registration: CTRI/2021/12/038928.
Language	English
Publishing date	2024-03-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.55764
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Article ; Online: Hybrid immunity versus vaccine-induced immunity against SARS-CoV-2 in patients with autoimmune rheumatic diseases.

Shenoy, Padmanabha / Ahmed, Sakir / Paul, Aby / Cherian, Somy / Umesh, Rashwith / Shenoy, Veena / Vijayan, Anuroopa / Babu, Sageer / S, Nivin / Thambi, Arya

The Lancet. Rheumatology

2021 Volume 4, Issue 2, Page(s) e80–e82

Language	English
Publishing date	2021-11-22
Publishing country	England
Document type	Journal Article
ISSN	2665-9913
ISSN (online)	2665-9913
DOI	10.1016/S2665-9913(21)00356-8
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Article ; Online: Autologous Stem-Cell Transplantation for Severe Scleroderma.

Shenoy, Padmanabha / Sreenath, Sreelakshmi / Aggarwal, Amita

The New England journal of medicine

2018 Volume 378, Issue 11, Page(s) 1066

MeSH term(s)	Hematopoietic Stem Cell Transplantation ; Humans ; Transplantation, Autologous
Language	English
Publishing date	2018--15
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc1801275
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Ua VI Zs.34: Show issues

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Article ; Online: Effects of face masks on oxygen saturation and functional measures in patients with connective tissue disorder-associated interstitial lung disease.

Vijayan, Anuroopa / Ahmed, Sakir / Joseph, Sneha / Sukumaran, Aswathy / Ahmed, Subin / Shenoy, Padmanabha

Annals of the rheumatic diseases

2021 Volume 80, Issue 11, Page(s) 1497–1498

MeSH term(s)	Adult ; Aged ; COVID-19/prevention & control ; Connective Tissue Diseases ; Dyspnea/etiology ; Female ; Humans ; Lung Diseases, Interstitial ; Male ; Masks/adverse effects ; Middle Aged ; Oxygen/blood ; SARS-CoV-2
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2021-05-10
Publishing country	England
Document type	Letter ; Randomized Controlled Trial
ZDB-ID	7090-7
ISSN	1468-2060 ; 0003-4967
ISSN (online)	1468-2060
ISSN	0003-4967
DOI	10.1136/annrheumdis-2021-220230
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Uh III Zs.114: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 167: Show issues

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Article ; Online: Osteopoikilosis and ankylosing spondylitis: Strange bedfellows: A case report.

Joseph, Rachel O / Thomas, Joe / Shenoy, Padmanabha

International journal of rheumatic diseases

2019 Volume 22, Issue 6, Page(s) 1162–1164

MeSH term(s)	Anti-Inflammatory Agents/therapeutic use ; Female ; Humans ; Osteopoikilosis/complications ; Osteopoikilosis/diagnostic imaging ; Spondylitis, Ankylosing/complications ; Spondylitis, Ankylosing/diagnostic imaging ; Spondylitis, Ankylosing/drug therapy ; Young Adult
Chemical Substances	Anti-Inflammatory Agents
Language	English
Publishing date	2019-05-14
Publishing country	England
Document type	Case Reports ; Letter
ZDB-ID	2426924-4
ISSN	1756-185X ; 1756-1841
ISSN (online)	1756-185X
ISSN	1756-1841
DOI	10.1111/1756-185X.13594
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Zs.A 6098: Show issues

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Article ; Online: Co prescription of anti-acid therapy reduces the bioavailability of mycophenolate mofetil in systemic sclerosis patients: A crossover trial.

Alex, Glaxon / Shanoj, K C / Varghese, Delcey Rachel / Sageer Babu, A S / Reji, Reshma / Shenoy, Padmanabha D

Seminars in arthritis and rheumatism

2023 Volume 63, Page(s) 152270

Abstract: Objective: Mycophenolate mofetil (MMF) is an effective treatment option for interstitial lung disease (ILD) in systemic sclerosis (SSc). Many patients require co-administration of proton pump inhibitors (PPI) or H2 receptor blockers (HRB) because of ... ...

Abstract	Objective: Mycophenolate mofetil (MMF) is an effective treatment option for interstitial lung disease (ILD) in systemic sclerosis (SSc). Many patients require co-administration of proton pump inhibitors (PPI) or H2 receptor blockers (HRB) because of various gastrointestinal (GI) manifestations in SSc. Co-treatment with PPI or HRB have shown to reduce serum drug levels in post-transplant patients. We wanted to see if there is a similar phenomenon for Mycophenolate in SSc. Methods: Twenty SSc patients, who were on a stable dose of MMF (1.5-3 g) underwent a sequential cross over study with MMF alone in the first month, followed by co-treatment with Ranitidine and then Esomeprazole in the second and third month respectively. Estimation of 12-hour area under curve (AUC) of Mycophenolic Acid (MPA) levels and total GI score were calculated at the end of each month and compared between the treatment arms. [Trial registration: CTRI/2020/06/025,939] RESULTS: Co-administration of esomeprazole was associated with 32.7% (mean difference = 22.28 μg h ml Conclusion: Co-administration of PPI or HRB can significantly reduce the bioavailability of MMF in patients with SSc. To avoid therapeutic failure of MMF drug level monitoring is essential when these agents are co-prescribed with MMF.
MeSH term(s)	Humans ; Mycophenolic Acid/therapeutic use ; Cross-Over Studies ; Esomeprazole/therapeutic use ; Ranitidine ; Biological Availability ; Immunosuppressive Agents/therapeutic use ; Proton Pump Inhibitors/therapeutic use ; Gastrointestinal Agents ; Scleroderma, Systemic/complications ; Scleroderma, Systemic/drug therapy
Chemical Substances	Mycophenolic Acid (HU9DX48N0T) ; Esomeprazole (N3PA6559FT) ; Ranitidine (884KT10YB7) ; Immunosuppressive Agents ; Proton Pump Inhibitors ; Gastrointestinal Agents
Language	English
Publishing date	2023-09-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	120247-9
ISSN	1532-866X ; 0049-0172
ISSN (online)	1532-866X
ISSN	0049-0172
DOI	10.1016/j.semarthrit.2023.152270
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Zs.A 790: Show issues

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Article ; Online: Low-dose rituximab protocol in rheumatoid arthritis-outcome and economic impact.

Chandramohan, Parvathypriya / Jain, Avinash / Antony, Glindow / Krishnan, Narayanan / Shenoy, Padmanabha

Rheumatology advances in practice

2021 Volume 5, Issue 1, Page(s) rkaa077

Abstract: Objectives: A significant proportion of RA patients, particularly those associated with poor prognostic factors, fail on conventional DMARDs (cDMARDs). Although rituximab (RTX) has been effective in these patients, the cost of therapy makes it ... ...

Abstract	Objectives: A significant proportion of RA patients, particularly those associated with poor prognostic factors, fail on conventional DMARDs (cDMARDs). Although rituximab (RTX) has been effective in these patients, the cost of therapy makes it unaffordable, particularly in poor and developing countries. Numerous, albeit small, studies using lower doses have shown contradictory results. We aimed to analyse the effectiveness of a low-dose RTX protocol based on clinical outcomes in RA patients. Methods: Seropositive RA patients with moderate to high disease activity (DAS28-ESR > 3.2) despite combination cDMARDs, treated with RTX, were included in retrospective analysis. All patients were treated according to a predefined protocol, using 500 mg RTX with ongoing cDMARDs at baseline and repeat dosing at 6 weeks or beyond, on lack of moderate to good EULAR response. The B cell count was assessed at baseline, 2 and 24 weeks. Results: At 12 weeks, 93% of 166 patients [mean (s.d.) age, 51.5 (11.96) years, 25 men and 141 women, with a disease duration of 10.4 (6.29) years] achieved moderate to good EULAR response. At 24 weeks, 90.8% of patients achieved moderate to good EULAR response, 19.8% achieved low disease activity and 29.5% achieved remission, with a mean change in DAS28-ESR from baseline of 2.9 (1.3). RTX failure and relapse were seen in 5.4% and 3.6%, respectively. The response was maintained for 12.3 (7.2) months with a mean RTX dose 521.1 (100.8) mg. Adverse events were seen in 9.6%. When compared with the standard dosing regimen with the originator molecule, a cost reduction of 90% was achieved. Conclusion: A low-dose RTX regimen achieved reasonably good clinical outcomes at the end of 6 months, with a significantly lower cost.
Language	English
Publishing date	2021-01-07
Publishing country	England
Document type	Journal Article
ISSN	2514-1775
ISSN (online)	2514-1775
DOI	10.1093/rap/rkaa077
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Article ; Online: Effectiveness of delayed second dose of AZD1222 vaccine in patients with autoimmune rheumatic disease.

Mehta, Pankti / Paul, Aby / Ahmed, Sakir / Cherian, Somy / Panthak, Ameya / Benny, Janet / Shenoy, Padmanabha

Clinical rheumatology

2022 Volume 41, Issue 11, Page(s) 3537–3542

Abstract: There is paucity of data on extended dosing interval between two doses of AZD1222 (AstraZeneca) in patients with Autoimmune Rheumatic Diseases (AIRD). We aimed to study the humoral response and rate of breakthrough infections between the two groups who ... ...

Abstract	There is paucity of data on extended dosing interval between two doses of AZD1222 (AstraZeneca) in patients with Autoimmune Rheumatic Diseases (AIRD). We aimed to study the humoral response and rate of breakthrough infections between the two groups who had received the second dose of vaccine at 4 weeks (Group 1) and 10-14 weeks (Group 2). From established cohort [COVID-19 vaccination cohort from CARE(CVCC)] of vaccinated patients with AIRD, those who had received AZD1222 were included and divided into two groups. Anti-Receptor Binding Domain (RBD) antibodies (IU/ml) were measured 1 month after the second dose. Its predictors and rate of breakthrough infections were studied. Four hundred ninety-five patients with AIRD were included in this study. Group 2 had higher anti-RBD antibody titres [1310.6 (±977.8) and [736 (±864.7), p = 0.0001. On univariate analysis, presence of Diabetes Mellitus; use of Methotrexate, Sulfasalazine, and Mycophenolate Mofetil; and vaccine interval were significantly associated with anti-RBD antibodies. Diabetes Mellitus and vaccine interval were independent predictors on multivariate analysis. Breakthrough infections were higher in Group 1 numerically on survival analysis but the difference was not significant (7.5% and 4.5%; log rank test: p = 0.25). In conclusion, increasing the gap between doses of the AZD1222 vaccine from 4 week to 10-14 weeks was found to be more beneficial in terms of antibody response in patients with AIRD. There was a trend towards higher breakthrough infections in the short interval group, supporting the antibody data. Key Points • There is paucity of data on effectiveness of increased dosing interval from 4-6 to 10-14 weeks for AZD1222 in patients with AIRDs • We observed a better humoral response with increased dosing interval with the interval and Diabetes Mellitus being independent predictors of the anti-RBD antibody levels • Breakthrough infections were numerically higher in the short interval group but the difference wasn't significant.
MeSH term(s)	Autoimmune Diseases ; COVID-19 ; COVID-19 Vaccines ; ChAdOx1 nCoV-19 ; Humans ; Methotrexate ; Mycophenolic Acid ; Rheumatic Diseases/drug therapy ; Sulfasalazine ; Vaccines
Chemical Substances	COVID-19 Vaccines ; Vaccines ; Sulfasalazine (3XC8GUZ6CB) ; ChAdOx1 nCoV-19 (B5S3K2V0G8) ; Mycophenolic Acid (HU9DX48N0T) ; Methotrexate (YL5FZ2Y5U1)
Language	English
Publishing date	2022-06-28
Publishing country	Germany
Document type	Journal Article
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-022-06247-3
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Zs.A 1740: Show issues

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Article ; Online: Correlates of breakthrough Omicron (B.1.1.529) infections in a prospective cohort of vaccinated patients with rheumatic diseases.

Benny, Libin / Mehta, Pankti / Ahmed, Sakir / Paul, Aby / Sukumaran, Aswathy / Mohanan, Manju / Vijayan, Anuroopa / Kaveri, K / Padmaja, R / Shenoy, Padmanabha

Rheumatology international

2023 Volume 43, Issue 6, Page(s) 1033–1039

Abstract: Background: Data on the effectiveness of SARS-CoV-2 vaccines and the durability of protection against the prevalent Omicron variant are scarce, especially in patients with autoimmune rheumatic diseases (AIRDs). Hence, we prospectively studied Omicron ... ...

Abstract	Background: Data on the effectiveness of SARS-CoV-2 vaccines and the durability of protection against the prevalent Omicron variant are scarce, especially in patients with autoimmune rheumatic diseases (AIRDs). Hence, we prospectively studied Omicron breakthrough infections in patients with AIRDs and attempted to isolate associated risk factors. Methods: Patients with AIRDs who had completed primary vaccination with either AZD1222 or BBV152 vaccines were included and prospectively followed up from January 2022 onwards for the development of breakthrough Omicron infections. The time interval from the last event [2nd dose of vaccination (V) or past COVID-19 infection (I) whichever was later] to Omicron infection was recorded. Patients were divided based on the events and their order of occurrence into V + V, V + I, I + V, V + I + V, and V + V + I groups. The incidence of breakthrough infections and their predictors were studied with a focus on the vaccine type and hybrid (H) immunity (vaccinated individuals with a history of COVID-19 infection). Results: We included 907 patients with AIRDs (53.5 ± 11.7 years and a male-to-female ratio of 1:5.1), and the majority of patients had received AZD1222 (755, 83.2%). Breakthrough infections were observed in 158 of 907(17.4%) of which 97 (10.4%) were confirmed by RT-PCR. Breakthrough infections were significantly greater in the V versus the H group (15.7% and 3.5%, log-rank test, p = < 0.01). Among the hybrid group, the order of infection and vaccination had no bearing on the risk of breakthrough infections. On multivariate analysis, breakthrough infections were significantly lesser in the H versus the V group [HR: 0.2(0.1-0.4); p = 0.01]. Conclusion: The risk of breakthrough Omicron infections in fully vaccinated patients with AIRDs was 17.4% with a significantly lower risk in patients with hybrid immunity.
MeSH term(s)	Humans ; Female ; Male ; COVID-19 ; COVID-19 Vaccines ; ChAdOx1 nCoV-19 ; Prospective Studies ; SARS-CoV-2 ; Rheumatic Diseases ; Autoimmune Diseases ; Breakthrough Infections
Chemical Substances	BBV152 COVID-19 vaccine (76JZE5DSN6) ; COVID-19 Vaccines ; ChAdOx1 nCoV-19 (B5S3K2V0G8)
Language	English
Publishing date	2023-04-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	8286-7
ISSN	1437-160X ; 0172-8172
ISSN (online)	1437-160X
ISSN	0172-8172
DOI	10.1007/s00296-023-05314-5
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