Session: Immunological Complications of Medical Therapy Poster
1982: Comparison of COVID-19 Infection and Mortality Rates in Vaccinated and Unvaccinated Patients with Autoimmune Inflammatory Rheumatic Disease (AIRD) Using Conventional and Biologic DMARD Therapy at an Urban Tertiary Care Hospital
University of Missouri Kansas City Overland Park, Kansas, United States
No financial relationships with ineligible companies to disclose
Sarah Ifteqar1, Mallak Zatreh2, Aatif Syed1, Xiangni Wu3, Asad Kabir4, John Foxworth5 and AMR EDREES6, 1University of Missouri Kansas City, Kansas City, MO, 23. Hutchinson Regional Medical Center, Hutchinson, Kansas, USA, Kansas City, 3UMKC, KANSAS CITY, MO, 45. Pulmonary Critical Care, Mosaic Life Care Health System, St. Joseph, Missouri, USA, Kansas City, 52. Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA, Kansas City, 6UMKC, Overland Park, KS Background/Purpose: Autoimmune inflammatory rheumatic diseases (AIRD) such as rheumatoid arthritis and systemic lupus erythematosus affect 3-5% of Americans and causes significant morbidity due to chronic inflammation and immune dysfunction1. Patients with AIRD are vulnerable to infections due to their immune abnormalities and immunosuppressive therapies, including Disease modifying anti-rheumatic drug (DMARD) therapy2. Understanding the impact of these treatments on COVID-19 outcomes is crucial. With COVID-19 vaccination, there's an opportunity to protect this high-risk group3,4. However, there's inadequate data on vaccination rates, efficacy, and adverse events among patients’ with AIRD. This study compares the incidence of COVID-19 between patients on biological and conventional DMARDs. Methods: A retrospective cross-sectional study was conducted from March 1st, 2020 to April 30th, 2022. Adult patients on immunosuppressive therapy (prednisone >=5mg, conventional and biologic DMARDs) at a rheumatology clinic were included. Statistical analysis used Chi-square tests for categorical variables and t-tests for continuous variables, with significance set at p < 0.05. Confidence intervals (95%) were calculated to assess estimate precision. Results: The study included 790 patients, predominantly female (81.8%), with a racial composition of 39.4% Caucasian, 48.0% African American, and 12.5% Other. The most common diagnoses were rheumatoid arthritis (40.9%), Systemic Lupus Erythematosus (16.5%), and Psoriatic Arthritis (9.4%). COVID-19 incidence was 16.3%, with no significant differences across gender (12.5% in males vs. 17.2% in females, p = 0.169, 95% CI: -0.870 to 4.177) or ethnicity (16.1% in Caucasians, 15.3% in African Americans, and 21.2% in Others, p = 0.362). Treatment regimens included hydroxychloroquine (31.3%), methotrexate (18.4%), adalimumab (11.0%), and etanercept (6.7%), with 23.3% receiving biologics and 76.7% DMARDs. No significant difference in COVID-19 infection rates was observed between biologics (18.5%) and DMARDs (15.7%, p = 0.368, 95% CI: -0.806 to 4.113). Higher infection rates were noted for guselkumab (66.7%) and apremilast, methotrexate (50%). Mortality was low with seven deaths, but a higher death rate was associated with abatacept (7.1%) and mycophenolate (6.5%). Despite high vaccination rates, vaccinated patients showed a higher incidence of COVID-19, likely due to underlying factors. Conclusion: This study suggests that conventional and biological DMARD use does not increase the risk of SARS-CoV-2 infection or COVID-19-related mortality in patients with AIRD, irrespective of vaccination status. Despite high vaccination rates, vaccinated individuals had a higher incidence of COVID-19, likely due to other factors. Specific immunotherapies such as abatacept (7.1%) and mycophenolate (6.5%) were associated with higher mortality rates, emphasizing the need for careful monitoring. The findings support the safe use of DMARD therapy in managing AIRD during the COVID-19 pandemic.
S. Ifteqar: None; M. Zatreh: None; A. Syed: None; X. Wu: None; A. Kabir: None; J. Foxworth: None; A. EDREES: None.