Characteristics Of And Risk Factors For COVID-19 Breakthrough Infections In Idiopathic Inflammatory Myopathies: Results From The COVAD Study.

Abstract

Objectives: 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. Methods: A validated patient self-reporting e-survey was circulated by the COVAD study group to collect data on COVID-19 infection and vacci nation 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. Results: 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) ¼ 0.98, 95% CI ¼ 0.97–0.99], and HCQ and SSZ use were risk factors (HR ¼ 1.81, 95% CI ¼ 1.24–2.64, and HR ¼ 3.79, 95% CI ¼ 1.69–8.42, respectively). Glucocorticoid use was a risk factor for a severe BI (HR ¼ 3.61, 95% CI ¼ 1.09–11.8). Non-white ethnicity (HR ¼ 2.61, 95% CI ¼ 1.03–6.59) was a risk factor for hospitalization. Compared with other groups, patients with IIMs required more supplemental oxygen therapy (IIMs ¼ 6.0% vs AIRDs ¼ 1.8%, nrAIDs ¼ 2.2% and HCs ¼ 0.9%), intensive care unit admission (IIMs ¼ 2.2% vs AIRDs ¼ 0.6%, nrAIDs and HCs ¼ 0%), advanced treatment with antiviral or monoclonal antibodies (IIMs ¼ 34.1% vs AIRDs ¼ 25.8%, nrAIDs ¼ 14.6% and HCs ¼ 12.8%) and had more hospitalization (IIMs ¼ 7.7% vs AIRDs ¼ 4.6%, nrAIDs ¼ 1.1% and HCs ¼ 1.5%). Conclusion: Patients with IIMs are susceptible to severe COVID-19 BIs. Age and immunosuppressive treatments were related to the risk of BIs.