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

Naveen R; Parikshit Sen; Zoltán Griger; Jessica Day; Mrudula Joshi; Arvind Nune; Elena Nikiphorou; Sreoshy Saha; Ai Lyn Tan; Samuel Katsuyuki Shinjo; Nelly Ziade; Tsvetelina Velikova; Marcin Milchert; Kshitij Jagtap; Ioannis Parodis; Abraham Edgar Gracia-Ramos; Lorenzo Cavagna; Masataka Kuwana; Johannes Knitza; Yi Ming Chen; Ashima Makol; Vishwesh Agarwal; Aarat Patel; John D Pauling; Chris Wincup; Bhupen Barman; Erick Adrian Zamora Tehozol; Jorge Rojas Serrano; Ignacio García-De La Torre; Iris J Colunga-Pedraza; Latika Gupta; COVAD Study Group; et al

doi:10.1093/rheumatology/kead180

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

Naveen R, Parikshit Sen, Zoltán Griger, Jessica Day, Mrudula Joshi, Arvind Nune, Elena Nikiphorou, Sreoshy Saha, Ai Lyn Tan, Samuel Katsuyuki Shinjo, Nelly Ziade, Tsvetelina Velikova, Marcin Milchert, Kshitij Jagtap, Ioannis Parodis, Abraham Edgar Gracia-Ramos, Lorenzo Cavagna, Masataka Kuwana, Johannes Knitza, Yi Ming ChenAshima Makol, Vishwesh Agarwal, Aarat Patel, John D Pauling, Chris Wincup, Bhupen Barman, Erick Adrian Zamora Tehozol, Jorge Rojas Serrano, Ignacio García-De La Torre, Iris J Colunga-Pedraza, Latika Gupta^*, COVAD Study Group , et al

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

10 Citations (Scopus)

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 < 0.001) were associated with disparity between self-reported and IS-denoted flares.

Conclusion:

A diagnosis of IIMs confers an equal risk of flares in the post–COVID-19 vaccination period to AIRDs, with active disease, female gender and comorbidities conferring a higher risk. Disparity between patient- and physician-reported outcomes represents a future avenue for exploration.

Original language	English
Pages (from-to)	127-139
Number of pages	13
Journal	Rheumatology
Volume	63
Issue number	1
Early online date	21 Apr 2023
DOIs	https://doi.org/10.1093/rheumatology/kead180
Publication status	Published - 4 Jan 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Female
Humans
Male
Middle Aged
Autoimmune Diseases/physiopathology
COVID-19/prevention & control
COVID-19 Vaccines/adverse effects
Myositis/physiopathology
Surveys and Questionnaires
Vaccination/adverse effects
Disease Progression
Rheumatic Diseases/physiopathology

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10.1093/rheumatology/kead180

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R, N., Sen, P., Griger, Z., Day, J., Joshi, M., Nune, A., Nikiphorou, E., Saha, S., Tan, A. L., Shinjo, S. K., Ziade, N., Velikova, T., Milchert, M., Jagtap, K., Parodis, I., Gracia-Ramos, A. E., Cavagna, L., Kuwana, M., Knitza, J., ... al , E. (2024). Flares in IIMs and the timeline following COVID-19 vaccination: a combined analysis of the COVAD-1 and -2 surveys. Rheumatology, 63(1), 127-139. https://doi.org/10.1093/rheumatology/kead180

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

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 < 0.001) were associated with disparity between self-reported and IS-denoted flares. Conclusion:A diagnosis of IIMs confers an equal risk of flares in the post–COVID-19 vaccination period to AIRDs, with active disease, female gender and comorbidities conferring a higher risk. Disparity between patient- and physician-reported outcomes represents a future avenue for exploration.",

keywords = "Female, Humans, Male, Middle Aged, Autoimmune Diseases/physiopathology, COVID-19/prevention \& control, COVID-19 Vaccines/adverse effects, Myositis/physiopathology, Surveys and Questionnaires, Vaccination/adverse effects, Disease Progression, Rheumatic Diseases/physiopathology",

author = "Naveen R and Parikshit Sen and Zolt{\'a}n Griger and Jessica Day and Mrudula Joshi and Arvind Nune and Elena Nikiphorou and Sreoshy Saha and Tan, \{Ai Lyn\} and Shinjo, \{Samuel Katsuyuki\} and Nelly Ziade and Tsvetelina Velikova and Marcin Milchert and Kshitij Jagtap and Ioannis Parodis and Gracia-Ramos, \{Abraham Edgar\} and Lorenzo Cavagna and Masataka Kuwana and Johannes Knitza and Chen, \{Yi Ming\} and Ashima Makol and Vishwesh Agarwal and Aarat Patel and Pauling, \{John D\} and Chris Wincup and Bhupen Barman and \{Zamora Tehozol\}, \{Erick Adrian\} and \{Rojas Serrano\}, Jorge and \{Garc{\'i}a-De La Torre\}, Ignacio and Colunga-Pedraza, \{Iris J\} and Latika Gupta and \{COVAD Study Group\} and et al",

year = "2024",

month = jan,

day = "4",

doi = "10.1093/rheumatology/kead180",

language = "English",

volume = "63",

pages = "127--139",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "1",

}

R, N, Sen, P, Griger, Z, Day, J, Joshi, M, Nune, A, Nikiphorou, E, Saha, S, Tan, AL, Shinjo, SK, Ziade, N, Velikova, T, Milchert, M, Jagtap, K, Parodis, I, Gracia-Ramos, AE, Cavagna, L, Kuwana, M, Knitza, J, Chen, YM, Makol, A, Agarwal, V, Patel, A, Pauling, JD, Wincup, C, Barman, B, Zamora Tehozol, EA, Rojas Serrano, J, García-De La Torre, I, Colunga-Pedraza, IJ, Gupta, L, COVAD Study Group & al , E 2024, 'Flares in IIMs and the timeline following COVID-19 vaccination: a combined analysis of the COVAD-1 and -2 surveys', Rheumatology, vol. 63, no. 1, pp. 127-139. https://doi.org/10.1093/rheumatology/kead180

TY - JOUR

T1 - Flares in IIMs and the timeline following COVID-19 vaccination

T2 - a combined analysis of the COVAD-1 and -2 surveys

AU - R, Naveen

AU - Sen, Parikshit

AU - Griger, Zoltán

AU - Day, Jessica

AU - Joshi, Mrudula

AU - Nune, Arvind

AU - Nikiphorou, Elena

AU - Saha, Sreoshy

AU - Tan, Ai Lyn

AU - Shinjo, Samuel Katsuyuki

AU - Ziade, Nelly

AU - Velikova, Tsvetelina

AU - Milchert, Marcin

AU - Jagtap, Kshitij

AU - Parodis, Ioannis

AU - Gracia-Ramos, Abraham Edgar

AU - Cavagna, Lorenzo

AU - Kuwana, Masataka

AU - Knitza, Johannes

AU - Chen, Yi Ming

AU - Makol, Ashima

AU - Agarwal, Vishwesh

AU - Patel, Aarat

AU - Pauling, John D

AU - Wincup, Chris

AU - Barman, Bhupen

AU - Zamora Tehozol, Erick Adrian

AU - Rojas Serrano, Jorge

AU - García-De La Torre, Ignacio

AU - Colunga-Pedraza, Iris J

AU - Gupta, Latika

AU - COVAD Study Group

AU - al , et

PY - 2024/1/4

Y1 - 2024/1/4

N2 - 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 < 0.001) were associated with disparity between self-reported and IS-denoted flares. Conclusion:A diagnosis of IIMs confers an equal risk of flares in the post–COVID-19 vaccination period to AIRDs, with active disease, female gender and comorbidities conferring a higher risk. Disparity between patient- and physician-reported outcomes represents a future avenue for exploration.

AB - 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 < 0.001) were associated with disparity between self-reported and IS-denoted flares. Conclusion:A diagnosis of IIMs confers an equal risk of flares in the post–COVID-19 vaccination period to AIRDs, with active disease, female gender and comorbidities conferring a higher risk. Disparity between patient- and physician-reported outcomes represents a future avenue for exploration.

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Autoimmune Diseases/physiopathology

KW - COVID-19/prevention & control

KW - COVID-19 Vaccines/adverse effects

KW - Myositis/physiopathology

KW - Surveys and Questionnaires

KW - Vaccination/adverse effects

KW - Disease Progression

KW - Rheumatic Diseases/physiopathology

U2 - 10.1093/rheumatology/kead180

DO - 10.1093/rheumatology/kead180

M3 - Article (Academic Journal)

C2 - 37084267

SN - 1462-0324

VL - 63

SP - 127

EP - 139

JO - Rheumatology

JF - Rheumatology

IS - 1

ER -

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

Abstract

Bibliographical note

UN SDGs

Keywords

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