Covid Risk for Autoimmune Patients

General
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Great article: https://www.medpagetoday.com/rheumatology/generalrheumatology/91022?vpass=1
This is aproffesional Membership site by the text of the article in part says; (Note the comment about our old friend Predi) and as they said “A limitation of the study was its retrospective design.”

"Another study has provided reassuring data on COVID-19 outcomes among patients with underlying autoimmune and chronic inflammatory diseases, though highlighting the potential risks of corticosteroid use.

In a multicenter retrospective study, no increased risk for mechanical ventilation or death associated with COVID-19 was seen for patients with autoimmune or chronic inflammatory diseases (OR 1.3, 95% CI 0.9-1.8, P =0.235), according to Ryan C. Ungaro, MD, and colleagues from the Icahn School of Medicine at Mount Sinai in New York City.

However, treatment with systemic corticosteroids raised the risk significantly, with an odds ratio of 6.8 (95% CI 2.5-18.4, P <0.001), the researchers reported online in ACR Open Rheumatology .

Similar results were observed in a report from last summer of outcomes among patients with inflammatory bowel diseases, also by Ungaro and colleagues, in which the standardized mortality ratio for patients with inflammatory bowel disease in the U.S. was 1.7 (95% CI 0.9-2.5), but the adjusted odds ratio for severe disease or mortality among patients on systemic corticosteroids was 6.9 (95% CI 2.3-20.5).

Concerns have been raised about elevated risks for severe COVID-19 among patients with underlying conditions that affect the immune system and who typically are treated with immunomodulating medications. “Autoimmune and chronic inflammatory diseases, prevalent in 5% to 7% of developed countries, are associated with an increased risk of infection related to immunosuppression and disease activity,” Ungaro’s group wrote.

But data are only beginning to emerge on COVID outcomes among patients with these underlying diseases, and how treatments might influence disease severity and complications.

To address these concerns, the researchers analyzed electronic health record data from five hospitals in the Mount Sinai Health System in New York for patients who tested positive for COVID-19 from March 1 to May 12, 2020.

Underlying diagnoses of interest included rheumatoid arthritis, inflammatory bowel disease, scleroderma, psoriasis/psoriatic arthritis, systemic lupus erythematosus, ankylosing spondylitis, vasculitis, Behcet’s disease, and autoimmune hepatitis or pancreatitis.

The analysis adjusted for risk factors including age over 70, sex, race, diabetes, cardiovascular disease, obesity, chronic kidney disease, and chronic obstructive pulmonary disease (COPD).

During the study period, 6,792 patients were identified as having PCR-confirmed COVID-19, with 2.3% (159) having an underlying autoimmune or inflammatory disease. The most common diseases were rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus.

Patients with underlying diseases were more likely to be female, white, to be obese, to have a history of asthma, and to have been diagnosed with a malignancy.

They also were more likely to be admitted to the hospital (84.3% vs 68.1%, P <0.001), but did not have higher rates of mechanical ventilation (28.3% vs 25.8%, P =0.534) or mortality (22.6% vs 21.8%, P =0.872).

On the multivariate analysis, underlying autoimmune or inflammatory disease showed no association with severe COVID-19 (mechanical ventilation or mortality), but several other factors did show significant associations ( P <0.001 for all):

** Age over 70, OR 3.1 (95% CI 2.7-3.5)*
** Male sex, OR 1.3 (95% CI 1.2-1.5)*
** Cardiovascular disease, OR 1.7 (95% CI 1.5-2.0)*
** Diabetes, OR 1.6 (95% CI 1.4-1.8)*
** Chronic kidney disease, OR 2.0 (95% CI 1.7-2.4)*
** COPD, OR 1.4 (95% CI 1.2-1.9)*
** Obesity, OR 1.4 (95% CI 1.2-1.6)*

With regard to the influence of treatments, while steroids were associated with a nearly sevenfold increased risk of severe COVID-19, there was no association for biologics (OR 1.0, 95% CI 0.3-3.5, P =0.977) or nonbiologic immunosuppressives (OR 0.7, 95% CI 0.3-1.8, P =0.434).

The finding that biologics and immunosuppressive drugs did not appear to increase the risk of severe COVID-19 was “an important observation,” according to the researchers.

"Overall, our data suggest that patients with autoimmune and chronic inflammatory diseases should stay on their medications during this pandemic with the exception of corticosteroids, which should ideally be tapered to the lowest possible dose weighing the risks and benefits of these therapies in the individual patient," they stated.

A limitation of the study was its retrospective design."

Disclosures

The authors reported support from the National Institutes of Health and the Crohn’s and Colitis Foundation.

They also reported financial relationships with Eli Lilly, Janssen, Pfizer, Takeda, AbbVie, Boehringer Ingelheim, Amgen, Allergan, Ferring Pharmaceuticals, Shire, Arena, Celgene, Celltrion, Enterome, Genentech, Landos, Ipsen, MedImmune, Merck, Novartis, TiGenix, Viela Bio, Intestinal Biotech Development, and Genfit.

Primary Source

ACR Open Rheumatology

Source Reference: Ungaro R, et al “Autoimmune and chronic inflammatory disease patients with COVID-19” ACR Open Rheum 2021; DOI: 10.1002/acr2.11221.

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I have found MedPage pretty informative without all the media BS. The reports they published are usually backed up with the numbers.

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This is good information - thank you for posting!

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@tntlamb This is a great article—it gives me some hope.

Yesterday I had a rapid COVID test and an antibody test. Both were negative. I’m relieved the COVID test was negative, but I’m not reassured knowing now I don’t have antibodies to COVID-19. I received my two doses of the Pfizer vaccine in February. I’ve been so confident about being immune, and now I have to throw my confidence to the wind!

I had heard Dr. Fauci say on TV a few weeks ago that it’s been found people on meds for certain types of arthritis and autoimmune disease aren’t developing antibodies from the vaccines. He said there are millions of people on these meds that haven’t developed antibodies. I asked my Rheumatologist about this, and he agreed but said there hasn’t been a decision on what to do about that. Dr. Fauci had said this would need to be studied further.

Now that I know I don’t have the antibodies and I’m betting a lot of my friends here don’t have them either—what do I (we) do? This article gave me reassurance that my biologic (Enbrel) won’t necessarily ruin my chances of recovering if I do catch COVID. I don’t take corticosteroids other than putting Betamethasone cream on some small patches of psoriasis.

@tntlamb thank you for posting this article. Is there anything else you can tell us, other than restart mask wearing, sanitizing and social distancing, to protect ourselves? Should we live in a bubble!?

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I wouldn’t blame this completely on the meds. As we age we have a lower immune response.

The other side of this is that the antibodies don’t last forever. Instead there’s memory immune cells that will ramp up antibody protection when we’re exposed.

So a few possible explanations

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That’s interesting and reassuring! Thanks @Stoney

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Fauci didn’t say that (in quite that way) and he is far from the end all. there was a small study done in Germany involving fewer than 100 patients using methotrexate and some biologic who I can’t recall. About 20% didn’t develop antibodies. A repeat study with a much larger number came it at less than 10%. Just about the same portion of the general population… When what you start to read on the net causes stress it’s time to turn off Google. You had your vaccine close to 6 mos ago just about how long they figured active antbodies would last initially without a third booster. The lack of active antibodies doesn’t mean that your immune system hasn’t been programmed to produce them when needed. That’s why a third booster hasn’t been determined necessary yet. It may be necessary and it may be like many other vaccines not necessary…
Also there not millions of autoimmune patients who have failed to produce antibodies. There aren’t millions of us to begin with… it’ll work out. I’m more worried about the 2 weeks of 95+ Temps effect on my Rose bushes and the hoot owl fishing hours on my favorite rivers.

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Thanks, @tntlamb. I always trust your knowledge on these things. Fauci did say millions, though, he was on CNN. That’s why I was so alarmed. He said people with auto-immune diseases such as rheumatoid arthritis, lupus, etc. (He didn’t mention PsA, but I assume because RA is treated with similar meds, PsA victims are at risk, too.) But he also mentioned it hasn’t been determined yet how this will be treated—he said possibly an extra booster vaccine.
Like you said, everyone might need a booster eventually—not just people on corticosteroids.

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They are planning a 3rd dose of the vaccine in the UK from September but the go ahead will be based on data results not available until August given the vaccine roll out only started in mid December. It’s basically planned for all those over 50 plus all clinically vulnerable people. Initially it just be the clinically vulnerable plus those over 70. I’ll keep you in the loop.

[quote=“tntlamb, post:7, topic:10552”]
The lack of active antibodies doesn’t mean that your immune system hasn’t been programmed to produce them when needed.
[/quote] I really like this bit.

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@tntlamb, did you have much of a reaction to the second vax?

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A little tired was it

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I didn’t have a reaction at all to either of the vaccines, nor did my husband. Not even the sore arm so many people mentioned. We had Pfizer.

Pfizer and Moderna are talking about a booster. I sure wish I could get one. I don’t wear a mask most places (kids’ sports, etc.). The places I do wear a mask are in busy grocery stores, and I only shop once a week, so hopefully we don’t have much chance of exposure to the virus.

How many of you still wear a mask—do you wear one every time you’re out in public? Has anyone caught Covid—if so, were you hospitalized for it?

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I had a decent reaction to the first Pfizer (hopefully that means antibodies), though I was having a flare at the time so it was a bit hard to separate them out, but I had vomiting and a stomach rash that I was pretty sure were not the flare.

Second one no reaction but I’d only stopped steroids 4 days prior (I feel so stupid for not thinking about it before I started them!)

If they offer a booster I’ll be lining up for it.

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I think masks work so although the UK is following the USA shortly (presently masks are manadatory) I won’t be going anywhere without one and indeed I’ll be doing a lot less for a quite a while given cases are surging in the UK presently. I haven’t caught Covid and I truly don’t want to at all.

I would always wear them around kids though given they are vectors for infecting others whilst being fine in themselves and I still don’t supermarket shop as I get them to deliver after an online order. I do go into other local stores which usually limit the number of people in them to one, two or max three people. But if those shops drop mask wearing and/or limiting the number of people, they won’t get my business anymore.

I had the Pfizer too but had no reaction to it other than being tired for a day and a sore arm. The doses were 12 weeks apart though. In the UK they are considering the booster for all the clinically vulnerable and everyone over the age of 50 from September. Although they are awaiting data not available until August before they make the final decision. And I’ll be clamouring for that booster too.

I remain very, very scared of Covid given they truly can’t tell us effectively if we’re protected given so many of antibody tests are so full of false positives and false negatives. And whilst I was cheered by what @tntlamb said the other day about our immune systems being primed regardless of the lack of antibodies - I don’t want to test that by exposing myself to Covid if at all possible.

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I had covid months ago, prior to being vaccinated. I was not hospitalized, but I did need to be managed at home. Honestly, part of what made me more comfortable being at home was being able to monitor my pulse ox. That plus once I started developing worsening symptoms I was in regular contact with my doctor and his physician assistant.

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My husband and I both had our 3rd Pfizer vaccine - I had mine in August. No reaction whatsoever. Currently a friend of a relative of mine is struggling with COVID symptoms even though she’s had the 3 vaccinations. She’s on a med for autoimmune disease—I’ll ask what med she’s on. Anyway, she’s pretty sick but feels if it weren’t for the vaccines she’d be a lot worse.

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