Patients With Systemic Autoimmune Rheumatic Diseases (SARDs) Are More Prone To More Severe Breakthrough SARS-CoV-2 Infections Warns Harvard Study!

The study findings from a new research by medical scientists from Harvard Medical School’s Massachusetts General Hospital-Boston and Brigham and Women’s Hospital-Boston have alarmingly revealed that patients with systemic autoimmune rheumatic diseases (SARDs) despite receiving full doses of the various COVID-19 vaccines are still prone to breakthrough SARS-CoV-2 infections. Alarmingly most of these breakthrough infections are often severe and fatal.

Systemic autoimmune rheumatic diseases SARDs are autoimmune diseases that include Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE) (and subsets of Lupus), Sjögren’s syndrome (SjS), Systemic Sclerosis (SSc), Polymyositis (PM), and Dermatomyositis (DM).
 
It should be noted that there are more than 200 distinct rheumatic diseases. Among the most common ones are: Osteoarthritis, Spondyloarthropathies -- ankylosing spondylitis (AS) and psoriatic arthritis (PsA), Gout, Scleroderma, Infectious arthritis, Juvenile idiopathic arthritis and Polymyalgia rheumatic.
 
The common theme in each of these diseases is the dysregulation of the immune system that causes the immune cells to attack autoantigens.
 
Of 340 confirmed COVID-19 infections among SARDs patients between December 11th, 2020 (date of first COVID-19 vaccine approval in the US) and July 30th, 2021, the study team identified 16 breakthrough infections. Seven (44%) received the Pfizer-BioNtech vaccine, five (31%) received the Moderna vaccine, and four (25%) received the Janssen/Johnson & Johnson vaccine.
 
The most common SARDs included rheumatoid arthritis (6, 38%), inflammatory myopathy (3, 19%), and systemic lupus erythematosus (3, 19%). Rituximab (5, 31%), glucocorticoids (4, 25%), and mycophenolate mofetil (4, 25%) were the most frequent treatments. Among the breakthrough infections, 15 (93%) were symptomatic, six (38%) were hospitalized, one (6%) required mechanical ventilation, and two (13%) died.
 
The study findings concluded that symptomatic, including severe, breakthrough infections were observed in SARDs patients; many were on treatments associated with attenuated antibody responses to vaccination. There is an urgent need for further detailed studies to determine the rate of breakthrough infection associated with SARD treatments and other features.
 
The study findings were published on a preprint server and are currently being peer reviewed. https://www.medrxiv.org/content/10.1101/2021.08.04.21261618v2
 
The study findings discuss the clinical characteristics and outcomes of patients with systemic autoimmune rheumatic diseases (SARDs) who were previously vaccinated against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus responsible for the coronavirus disease 2019 (COVID-19).
 
It was found that SARD patients are more susceptible to SARS-CoV-2 infections due to either active autoimmune disease or the types of medications they are prescribed. More specifically, many SARD patients are prescribed disease-modifying anti-rheumatic drugs (DMARDs).
 
It was observed throughout the ongoing COVID-19 pandemic that SARD patients remain at a higher risk of developing severe symptoms ofCOVID-19 disease.
 &l t;br /> It is reported that a small percentage of COVID-19 cases among SARD patients in a large United States healthcare system occurred among fully vaccinated patients.
 
It was also suspected that the use of DMARDs in this population, particularly glucocorticoids, methotrexate, mycophenolate mofetil, and rituximab, may reduce the immunologic response activated by COVID-19 vaccination.
 
To date, the post-vaccination risks associated with breakthrough COVID-19 infections among SARD patients are unknown. A breakthrough infection is defined as when a vaccinated individual becomes infected with the virus they are immunized against. Ultimately, the pathogen ‘breaks through’ the protection given by the vaccine.
 
In order to understand the COVID-19 vaccine breakthrough infection rate among SARD patients, the study team extracted the clinical details of SARD patients who received the COVID-19 vaccination 14 days or more prior to a positive SARS-CoV-2 molecular test.
 
The study team found that, as compared to the outcomes of breakthrough infections among the general population, a larger number of immunized SARD patients required hospitalization or died.
 
In the study, between December 11, 2020 and July 30, 2021, the study team identified 340 confirmed COVID-19 infections among SARD patients. Of these patients, 16 (4.7%) patients had breakthrough infections.
 
The study team considered the final vaccination dose as either the first dose in a one-dose series (Janssen/J&J) or the second dose in a two-dose vaccination series (Pfizer-BioNTech and Moderna).
 
It was found that among the 16 SARD patients who had breakthrough COVID-19 infections, 93% presented with symptoms. The most common symptoms reported by these individuals included fever, cough, and malaise, which affected 56%, 44%, and 38% of the patients, respectively. Six of the 16 patients were hospitalized, of which four required supplemental oxygen and one required mechanical ventilation. Two of the patients died(13%).
 
The study team observed that the most common SARDs included RA, inflammatory myositis, and SLE. The most frequent immunosuppressive medications that were being taken prior to first vaccine dose included rituximab, glucocorticoids, mycophenolate mofetil or mycophenolic acid, and methotrexate.
 
Notably, one SARD patient was medication-free (no DMARD or glucocorticoid) at the time of their COVID-19 vaccine, yet still presented with a COVID-19 breakthrough infection.
 
Corresponding author Dr Zachary S. Wallace, MD, MSc from the Clinical Epidemiology Program Division of Rheumatology, Allergy, and Immunology at Massachusetts General Hospital told Thailand Medical News, “This study complements observations regarding the attenuated antibody response to COVID-19 vaccination in patients with SARDs by identifying serious clinical outcomes from breakthrough infections in patients receiving DMARDs that have been reported to have blunted vaccine responses.”
 
The study however did have certain limitations, namely the current retrospective study cohort was small; therefore, further studies will need to be conducted to determine the rate of breakthrough infections associated with SARD treatments. It is also possible that SARDs patients with asymptomatic or less severe breakthrough infections were not included in the current study.
 
The study team concluded that a percentage of COVID-19 cases are reported among COVID-19-vaccinated SARD patients in a large healthcare system.
 
The team said that collectively, this study suggests that the blunted SARS-CoV-2 antibody response following COVID-19 vaccination in certain DMARD users may be associated with an increased risk of breakthrough infections that may be severe and even fatal.
 
The study findings also identify characteristics of COVID-19 breakthrough infections that may guide the prioritization of booster vaccines and other risk-mitigating strategies in patients with SARDs.
 
Most importantly all those with systemic autoimmune rheumatic diseases (SARDs) are to extra precautions and careful monitoring due to their vulnerability in the current pandemic.
 
Dear Readers please share this article with as many as possible especially loved ones and friends that may be having systemic autoimmune rheumatic diseases (SARDs) as American social media platforms and search engines and even American and British mainstream media would be trying to lower such articles or warnings in their news feeds as they do not want anyone to be informed about breakthrough infections.
 
For more on Breakthrough SARS-CoV-2 Infections, keep on logging to Thailand Medical News.