FLARES FOLLOWING COVID-19 VACCINATION IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES: COMBINED ANALYSIS FROM THE COVID-19 VACCINATION IN AUTOIMMUNE DISEASES (COVAD) STUDIESRheumatology, Maulana Azad Medical College, New Delhi, India.
Rheumatology, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India.
Rheumatology, Mymensingh Medical College, Mymensingh, Bangladesh.
Rheumatology, Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, India.
Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Centre for Rheumatic Diseases, King’s College London, London, United Kingdom; Rheumatology Department, King’s College Hospital, London, United Kingdom.
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom; Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.
Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paolo, Brazil.
Rheumatology Department, Saint-Joseph University, Beirut, Lebanon; Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland.
Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
Division of Rheumatology, Mayo Clinic, Rochester MN, USA.
Rheumatology, Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, United Kingdom; Department of Rheumatology, North Bristol NHS Trust, Bristol, United Kingdom.
Department of Rheumatology, Division of Medicine, Rayne Institute, University College London, London, United Kingdom; Centre for Adolescent Rheumatology Versus Arthritis, University College London, UCLH, GOSH, London, United Kingdom.
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, United Kingdom; Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
Rheumatology, Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom.
Department of Rheumatology, Royal Melbourne Hospital, Parkville, Australia; Department of Rheumatology, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
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, United Kingdom; National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, United Kingdom.
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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2023 (English)In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 62, no Suppl. 2, article id kead104.029Article in journal, Meeting abstract (Other academic) Published
Abstract [en]
Background/Aims: Flares following COVID-19 vaccination are an emerging concern among patients with rare rheumatic disease like idiopathic inflammatory myositis (IIMs), whereas data and understanding of this is rather limited. We aimed to study the prevalence, characteristics and determinants of IIM flares following COVID-19 vaccination.
Methods: CoVAD (COVID-19 Vaccination In Autoimmune Diseases) surveys are global patient self-reported e-surveys from 109 countries conducted in 2021 and 2022. Flares of IIM were defined by 4 definitions; a. patient self-reported, b. physician and immunosuppression (IS) denoted, c. sign directed (new erythematous rash, or worsening myositis or arthritis), d. MCID worsening of PROMISPF10a score between the patients who had taken both surveys. Descriptive statistics and multivariate regression were used to describe the predictors of flare. Cox-regression analysis was used to differentiate flares by IIM subtypes.
Results: Among the 1,278 IIM patients, aged 63 (50-71) years, 276 (21.5%) were dermatomyositis, 237 (18.5%) IBM, 899 (70.3%) were female and most were Caucasian (80.8%). Flares of IIM were seen in 123/1278 (9.6%), 163/1278 (12.7%), 112/1278 (8.7%), and 16/96 (19.6%) by definitions a-d respectively with median time to flare being 71.5 (10.7-235) days. Muscle weakness (69.1%), and fatigue (56.9%) were the most common symptoms of flare. The predictors of self-reported flare were: inactive/disease in remission prior to first dose of vaccine (OR ¼ 4.3, 95%CI¼2.4-7.6), and anxiety disorder (OR ¼ 2.2, 95%CI¼1.1-4.7). Rituximab use (OR ¼ 0.3, 95%CI¼0.1-0.7) and IBM (OR ¼ 0.3, 95%CI¼0.1-0.7) were protective. Physician defined flares were seen more often in females, mixed ethnicity, and those with asthma, ILD, and anxiety disorder (OR ranging 1.6-7.0, all p < 0.05). Notably, overlap myositis (OM) had higher HR for flare compared to polymyositis (HR ¼ 2.3, 95%CI¼1.2-4.4, p ¼ 0.010).
Conclusion: Nearly one in ten individuals with IIM develop flares after vaccination, more so among women, those with overlap myositis, and inactive disease prior to vaccination. Formal definition of flares in IIM is needed.
Place, publisher, year, edition, pages
Oxford University Press, 2023. Vol. 62, no Suppl. 2, article id kead104.029
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:oru:diva-109802ISI: 001082840200030OAI: oai:DiVA.org:oru-109802DiVA, id: diva2:1813205
Conference
British Society for Rheumatology Annual Conference (BSR 2023), Manchester, UK, April 24-26, 2023
2023-11-202023-11-202023-11-20Bibliographically approved