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COVID-19 vaccination outcomes among patients with dermatomyositis: a multicentered analysis

2022; Springer Science+Business Media; Volume: 41; Issue: 7 Linguagem: Inglês

10.1007/s10067-022-06081-7

1434-9949

Haig Pakhchanian, Ahmad Saud, Rahul Raiker, Sinan Kardeş, Rohit Aggarwal, Latika Gupta,

Muscle and Compartmental Disorders

The BNT162b2, mRNA-1273, and Ad26.COV.2.S are the three vaccines that have been instrumental in managing the COVID-19 pandemic in the USA.Despite these vaccines being granted Emergency-Use Authorization by the FDA, safety and efficacy are unclear among autoimmune rheumatic disease patients as these populations were excluded from clinical trials [1-3].Speculations have been rife that vaccines may trigger autoimmunity, contributing to vaccine hesitancy among those with autoimmune rheumatic disorders such as dermatomyositis (DM) [4].Therefore, the goal was to evaluate the safety and effectiveness of COVID-19 vaccination among DM patients when compared to vaccinated controls using data from a federated database.TriNetX (Cambridge, MA) is a multicenter research database that was used in this retrospective cohort study.Validated ICD-10 diagnostic codes and CPT codes were utilized to identify vaccinated patients with and without DM.Inclusion of DM patients was based on a diagnosis of ≥ 1 ICD-10 codes at least 1 year apart.1:1 propensity score matching (PSM) was then utilized to balance the two cohorts by demographics and comorbidities.Lastly, 1-day anaphylaxis along with 30-and 60-day adverse events of special interest (AESI) as defined by the CDC, breakthrough infection (BI), and all-cause hospitalization (ACH) were assessed using adjusted risk ratios and 95% confidence intervals.To protect the patient health information, TriNetX obfuscates aggregate patient counts ≤ 10 to prevent statistical analysis.Further details regarding this methodology are detailed in previous studies and in the supplement [5].Before PSM, 1,022,471 vaccinated individuals made up non-DM controls and were compared to 6104 vaccinated DM patients.On average, vaccinated DM patients were composed of older and comorbid patients with higher female and Black representation (Table 1).After PSM, two balanced cohorts of 6103 patients were compared to each another.DM patients did not have a difference in risk for immediate anaphylaxis at 1-day post-immunization (RR: 1.8 (CI: 0.96-3.38),p = 0.06), while absolute risk was minimal for DM patients (0.4%).At 30 days post-vaccination, vaccinated DM patients did not experience a difference in risk for AESI, BI, or ACH compared to the control population.However, at 60 days post-vaccination, the DM group had a greater risk for AESI compared to controls (RR: 1.96 (CI: 1.06-3.61),p = 0.028) with a small absolute risk of 0.6%.No differences in risk for BI and ACH were observed 60 days postvaccination (Table 2).DMARD and glucocorticoid use did not impact AESI, BI, or ACH at any time interval.Among the three administered vaccines, BI was greater among BNT162b2 (0.9% vs. 0.5%, p-0.026) though this was also the most common vaccine administered (4411/6104).Widespread efforts to vaccinate the public in attempts to achieve herd immunity makes it increasingly vital for rheumatologists to have an evidence base by which to address patient queries and avoid misinformation, especially surrounding the issue of immunosuppression [6,7].We observed a small absolute risk in DM patients;