Hoff Leonardo Santos, Ravichandran Naveen, Sen Parikshit, Day Jessica, Joshi Mrudula, Nune Arvind, Nikiphorou Elena, Saha Sreoshy, Tan Ai Lyn, Shinjo Samuel Katsuyuki, Ziade Nelly, Velikova Tsvetelina, Milchert Marcin, Jagtap Kshitij, Parodis Ioannis, Gracia-Ramos Abraham Edgar, Cavagna Lorenzo, Kuwana Masataka, Knitza Johannes, Chen Yi Ming, Makol Ashima, Agarwal Vishwesh, Patel Aarat, Pauling John D, Wincup Chris, Barman Bhupen, Tehozol Erick Adrian Zamora, Serrano Jorge Rojas, Torre Ignacio García-De La, Colunga-Pedraza Iris J, Merayo-Chalico Javier, Chibuzo Okwara Celestine, Katchamart Wanruchada, Goo Phonpen Akarawatcharangura, Shumnalieva Russka, El Kibbi Lina, Halabi Hussein, Vaidya Binit, Shaharir Syahrul Sazliyana, Hasan A T M Tanveer, Dey Dzifa, Gutiérrez Carlos Enrique Toro, Caballero-Uribe Carlo V, Lilleker James B, Salim Babur, Gheita Tamer, Chatterjee Tulika, Distler Oliver, Saavedra Miguel A, Chinoy Hector, Agarwal Vikas, Aggarwal Rohit, Gupta Latika
Department of Medicine, School of Medicine, Universidade Potiguar (UnP), Natal, Brazil.
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Rheumatology (Oxford). 2025 Feb 1;64(2):597-606. doi: 10.1093/rheumatology/keae128.
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.
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.
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%).
Patients with IIMs are susceptible to severe COVID-19 BIs. Age and immunosuppressive treatments were related to the risk of BIs.
本研究旨在利用自身免疫性疾病新冠疫苗接种（COVAD）研究的数据，探讨特发性炎性肌病（IIM）中新冠病毒突破性感染（BI）的患病率、特征和危险因素。
COVAD研究组发放了一份经过验证的患者自我报告电子调查问卷，以收集2022年新冠病毒感染和疫苗接种的数据。BI被定义为在两剂疫苗接种≥14天后发生的新冠病毒感染。我们比较了IIM患者、其他自身免疫性风湿性和非风湿性疾病（AIRD、nrAID）患者以及健康对照（HC）的BI特征和严重程度。使用多变量Cox回归模型评估IIM患者中BI、严重BI和住院的危险因素。
在纳入的9449份回复中，1447名受访者（15.3%）发生了BI。中位年龄为44岁[四分位间距（IQR）21]，77.4%为女性，1406名IIM患者中有182例（12.9%）发生了BI。IIM患者数据的多变量Cox回归显示，年龄增长是BI的保护因素[风险比（HR）=0.98，95%置信区间（CI）=0.97-0.99]，使用羟氯喹（HCQ）和柳氮磺胺吡啶（SSZ）是危险因素（HR分别为1.81，95%CI=1.24-2.64和HR=3.79，95%CI=1.69-8.42）。使用糖皮质激素是严重BI的危险因素（HR=3.61，95%CI=1.09-11.8）。非白人种族（HR=2.61，95%CI=1.03-6.59）是住院的危险因素。与其他组相比，IIM患者需要更多的补充氧气治疗（IIM=6.0%，而AIRD=1.8%，nrAID=2.2%，HC=0.9%）、重症监护病房入院（IIM=2.2%，而AIRD=0.6%，nrAID和HC=0%）、抗病毒或单克隆抗体的高级治疗（IIM=34.1%，而AIRD=25.8%，nrAID=14.6%，HC=12.8%），并且住院率更高（IIM=7.7%，而AIRD=4.6%，nrAID=1.1%，HC=1.5%）。
IIM患者易发生严重的新冠病毒BI。年龄和免疫抑制治疗与BI风险相关。
