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  1. Article ; Online: Immunomodulators and risk for breakthrough COVID-19 after third SARS-CoV-2 mRNA vaccine among patients with rheumatoid arthritis: a cohort study.

    Schiff, Abigail E / Wang, Xiaosong / Patel, Naomi J / Kawano, Yumeko / Hanberg, Jennifer L / Kowalski, Emily N / Cook, Claire E / Vanni, Kathleen Mm / Qian, Grace / Bade, Katarina J / Saavedra, Alene A / Srivatsan, Shruthi / Williams, Zachary K / Venkat, Rathnam K / Wallace, Zachary S / Sparks, Jeffrey A

    Annals of the rheumatic diseases

    2024  Volume 83, Issue 5, Page(s) 680–682

    MeSH term(s) Humans ; SARS-CoV-2 ; COVID-19 Vaccines ; Cohort Studies ; mRNA Vaccines ; COVID-19/prevention & control ; Immunologic Factors ; Arthritis, Rheumatoid ; Vaccination ; Antibodies, Viral
    Chemical Substances COVID-19 Vaccines ; mRNA Vaccines ; Immunologic Factors ; Antibodies, Viral
    Language English
    Publishing date 2024-04-11
    Publishing country England
    Document type Letter
    ZDB-ID 7090-7
    ISSN 1468-2060 ; 0003-4967
    ISSN (online) 1468-2060
    ISSN 0003-4967
    DOI 10.1136/ard-2023-225162
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Associations of DMARDs with post-acute sequelae of COVID-19 in patients with systemic autoimmune rheumatic diseases: a prospective study.

    Venkat, Rathnam K / Wang, Xiaosong / Patel, Naomi J / Kawano, Yumeko / Schiff, Abigail / Kowalski, Emily N / Cook, Claire E / Vanni, Kathleen M M / Qian, Grace / Bade, Katarina J / Saavedra, Alene / Srivatsan, Shruthi / Williams, Zachary K / Wallace, Zachary S / Sparks, Jeffrey A

    Rheumatology (Oxford, England)

    2023  

    Abstract: Objective: We investigated the baseline disease-modifying antirheumatic drug (DMARD) use and post-acute sequelae of COVID-19 (PASC) risk among patients with systemic autoimmune rheumatic diseases (SARDs).: Methods: Patients with SARDs and confirmed ... ...

    Abstract Objective: We investigated the baseline disease-modifying antirheumatic drug (DMARD) use and post-acute sequelae of COVID-19 (PASC) risk among patients with systemic autoimmune rheumatic diseases (SARDs).
    Methods: Patients with SARDs and confirmed COVID-19 infection at Mass General Brigham completed a survey ≥28 days after positive PCR/Antigen test to prospectively investigate their COVID-19 courses. We investigated DMARD use at COVID-19 onset and PASC risk. PASC was defined as any COVID-19 symptom that persisted for ≥28 days. We used logistic regression to estimate odds ratios (OR) for PASC by DMARD class. We also used restricted mean survival time to determine the difference in symptom-free days by DMARD class in the 28-day period after infection.
    Results: We analyzed 510 patients with SARDs and COVID-19 from 11/Mar/2021-17/Jun/2023; 202 (40%) developed PASC. CD20 inhibitor (CD20i) users had significantly higher odds of developing PASC vs csDMARD users (adjusted OR 2.69, 95%CI 1.23-5.88). IL-12/23, IL-17A, or IL-23 inhibitor (IL-12/23i, IL-17Ai, IL-23i) users also had significantly higher odds of PASC (adjusted OR 3.03, 95%CI 1.08-8.49). CD20i users had significantly fewer symptom-free days vs csDMARD users (adjusted -4.12, 95%CI -7.29 to -0.94).
    Conclusion: CD20i users had significantly higher odds of PASC and fewer symptom-free days over the 28 days following COVID-19 diagnosis compared with csDMARD users. Further research is needed to investigate whether PASC risk in CD20i users may be due to prolonged infection or other immune mechanisms. The association of IL-12/23i, IL-17Ai, and IL-23i and PASC calls for additional study.
    Language English
    Publishing date 2023-12-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 1464822-2
    ISSN 1462-0332 ; 1462-0324
    ISSN (online) 1462-0332
    ISSN 1462-0324
    DOI 10.1093/rheumatology/kead662
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Immunomodulators and risk for breakthrough infection after third COVID-19 mRNA vaccine among patients with rheumatoid arthritis: A cohort study.

    Schiff, Abigail E / Wang, Xiaosong / Patel, Naomi J / Kawano, Yumeko / Kowalski, Emily N / Cook, Claire E / Vanni, Kathleen M M / Qian, Grace / Bade, Katarina J / Saavedra, Alene A / Srivatsan, Shruthi / Williams, Zachary K / Venkat, Rathnam K / Wallace, Zachary S / Sparks, Jeffrey A

    medRxiv : the preprint server for health sciences

    2023  

    Abstract: Objectives: To investigate COVID-19 breakthrough infection after third mRNA vaccine dose among patients with RA by immunomodulator drug class, and we hypothesized that CD20 inhibitors (CD20i) would have higher risk for breakthrough COVID-19 vs. TNF ... ...

    Abstract Objectives: To investigate COVID-19 breakthrough infection after third mRNA vaccine dose among patients with RA by immunomodulator drug class, and we hypothesized that CD20 inhibitors (CD20i) would have higher risk for breakthrough COVID-19 vs. TNF inhibitors (TNFi).
    Methods: We performed a retrospective cohort study investigating breakthrough COVID-19 among RA patients at Mass General Brigham in Boston, MA, USA. Patients were followed from the date of 3rd vaccine dose until breakthrough COVID-19, death, or end of follow-up (18/Jan/2023). Covariates included demographics, lifestyle, comorbidities, and prior COVID-19. We used Cox proportional hazards models to estimate breakthrough COVID-19 risk by immunomodulator drug class. We used propensity score (PS) overlap-weighting to compare users of CD20i vs. TNFi.
    Results: We analyzed 5781 patients with RA that received 3 mRNA vaccine doses (78.8% female, mean age 64.2 years). During mean follow-up of 12.8 months, 1173 (20.2%) had breakthrough COVID_19. Use of CD20i (adjusted HR 1.74, 95%CI 1.30-2.33) and glucocorticoid monotherapy (adjusted HR 1.47, 95%CI 1.09-1.98) were each associated with breakthrough COVID-19 compared to TNFi use. In the PS overlap-weighted analysis, CD20i users also had higher breakthrough COVID-19 risk than TNFi users (HR 1.62, 95%CI 1.02-2.56). A sensitivity analysis excluding patients with cancer or interstitial lung disease yielded similar findings.
    Conclusions: We identified CD20i and glucocorticoid monotherapy as risk factors for breakthrough COVID-19 among patients with RA after a 3rd vaccine dose. This contemporary study highlights the real-world impact of blunted immune responses in these subgroups and the need for effective risk mitigation strategies.
    Language English
    Publishing date 2023-10-09
    Publishing country United States
    Document type Preprint
    DOI 10.1101/2023.10.08.23296717
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Immunomodulators and risk for breakthrough infection after third COVID-19 mRNA vaccine among patients with rheumatoid arthritis: A cohort study

    Schiff, Abigail E. / Wang, Xiaosong / Patel, Naomi J. / Kawano, Yumeko / Kowalski, Emily N. / Cook, Claire E. / Vanni, Kathleen M.M. / Qian, Grace / Bade, Katarina J. / Saavedra, Alene A. / Srivatsan, Shruthi / Williams, Zachary K. / Venkat, Rathnam K. / Wallace, Zachary S. / Sparks, Jeffrey A.

    medRxiv

    Abstract: Objectives: To investigate COVID-19 breakthrough infection after third mRNA vaccine dose among patients with RA by immunomodulator drug class, and we hypothesized that CD20 inhibitors (CD20i) would have higher risk for breakthrough COVID-19 vs. TNF ... ...

    Abstract Objectives: To investigate COVID-19 breakthrough infection after third mRNA vaccine dose among patients with RA by immunomodulator drug class, and we hypothesized that CD20 inhibitors (CD20i) would have higher risk for breakthrough COVID-19 vs. TNF inhibitors (TNFi). Methods: We performed a retrospective cohort study investigating breakthrough COVID-19 among RA patients at Mass General Brigham in Boston, MA, USA. Patients were followed from the date of 3rd vaccine dose until breakthrough COVID-19, death, or end of follow-up (18/Jan/2023). Covariates included demographics, lifestyle, comorbidities, and prior COVID-19. We used Cox proportional hazards models to estimate breakthrough COVID-19 risk by immunomodulator drug class. We used propensity score (PS) overlap-weighting to compare users of CD20i vs. TNFi. Results: We analyzed 5781 patients with RA that received 3 mRNA vaccine doses (78.8% female, mean age 64.2 years). During mean follow-up of 12.8 months, 1173 (20.2%) had breakthrough COVID_19. Use of CD20i (adjusted HR 1.74, 95%CI 1.30-2.33) and glucocorticoid monotherapy (adjusted HR 1.47, 95%CI 1.09-1.98) were each associated with breakthrough COVID-19 compared to TNFi use. In the PS overlap-weighted analysis, CD20i users also had higher breakthrough COVID-19 risk than TNFi users (HR 1.62, 95%CI 1.02-2.56). A sensitivity analysis excluding patients with cancer or interstitial lung disease yielded similar findings. Conclusions: We identified CD20i and glucocorticoid monotherapy as risk factors for breakthrough COVID-19 among patients with RA after a 3rd vaccine dose. This contemporary study highlights the real-world impact of blunted immune responses in these subgroups and the need for effective risk mitigation strategies.
    Keywords covid19
    Language English
    Publishing date 2023-10-09
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2023.10.08.23296717
    Database COVID19

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