Symptoms and Severity of COVID-19 in Patients with Immune-Mediated Inflammatory Diseases: Experience of a University Medical Center

Overview

Journal Autoimmune Dis

Publisher Wiley

Date 2024 Apr 4

PMID 38571561

Authors

Tobias Schlosser

Marco Krasselt

Louis Elsing

Martin Hecker

Babett Holler

Albrecht Hoffmeister

Affiliations

Soon will be listed here.

Abstract

Background: The pandemic situation of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) and its associated disease (coronavirus disease 2019 (COVID-19)) represents a challenging condition with a plethora of aspects. The course of COVID-19 in patients with immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD) and rheumatic diseases (RD) is not well known. Our study is one step toward closing this gap by collecting data on vaccination rates, infection-free survival, and individual symptom severity.

Methods: We conducted a prospective questionnaire-based study between April 2022 and October 2022 at our university hospital. Outward patients over the age of 18 years were screened for participation and reported about their infection/infection-free survival since the start of the pandemic.

Results: Finally, 156 patients were included in the study, 117 (75.0%) of which had inflammatory bowel disease and 39 (25.0%) patients with rheumatic disease. Altogether, 143 (91.7%) persons had received at least one vaccination against SARS-CoV-2. A total of 153 patients provided information regarding their COVID-19 history: 81 patients (52.0%) self-reported about their SARS-CoV-2 infection. In general, courses of infection were mild: only two patients (2.5% of patients with reported COVID-19) were hospitalized due to COVID-19 with one (1.2%) of the two needing intensive care. Asymptomatic COVID-19 had been described by 7 persons (8.6% of patients with reported COVID-19). Acute COVID-19 was accompanied by fatigue/tiredness in 58 persons (71.6% of patients with history of COVID-19) as the most frequent symptom. Other complaints were common cold (55 patients = 67.9%), cough (51 patients = 63.0%), headache (44 patients = 54.3%), and fever (35 patients = 43.2%). Stratified by vaccination status (unvaccinated vs. at least once vaccinated), the time to infection differed significantly (logrank test: = 0.04, Chi 4.1). At least once vaccinated people had a median COVID-19-free survival of 28.5 months (confidence interval (CI): 23.6 months-not reached). Without any vaccination, the estimated time to infection was 25.1 months (CI: 23.6 months-not reached).

Conclusion: Our IMID patients have a high rate of vaccination against SARS-CoV-2. Data show a significantly longer infection-free survival in vaccinated IMID patients as compared to unvaccinated patients. Discrimination between symptoms of COVID-19 and a concomitant inflammatory disease is difficult as complaints might be overlapping. This trial is registered with DRKS00028880.

References

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

Avouac J, Drumez E, Hachulla E, Seror R, Georgin-Lavialle S, El Mahou S . COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study. Lancet Rheumatol. 2021; 3(6):e419-e426. PMC: 7993930. DOI: 10.1016/S2665-9913(21)00059-X. View

Peto R, Pike M, Armitage P, Breslow N, Cox D, Howard S . Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977; 35(1):1-39. PMC: 2025310. DOI: 10.1038/bjc.1977.1. View

Ursini F, Ciaffi J, Mancarella L, Lisi L, Brusi V, Cavallari C . Fibromyalgia: a new facet of the post-COVID-19 syndrome spectrum? Results from a web-based survey. RMD Open. 2021; 7(3). PMC: 8384499. DOI: 10.1136/rmdopen-2021-001735. View

Piltch-Loeb R, Savoia E, Goldberg B, Hughes B, Verhey T, Kayyem J . Examining the effect of information channel on COVID-19 vaccine acceptance. PLoS One. 2021; 16(5):e0251095. PMC: 8116041. DOI: 10.1371/journal.pone.0251095. View

Gianfrancesco M, Hyrich K, Al-Adely S, Carmona L, Danila M, Gossec L . Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2020; 79(7):859-866. PMC: 7299648. DOI: 10.1136/annrheumdis-2020-217871. View

Krasselt M, Baerwald C, Seifert O . COVID-19 Vaccination Coverage in Patients with Rheumatic Diseases in a German Outpatient Clinic: An Observational Study. Vaccines (Basel). 2022; 10(2). PMC: 8880778. DOI: 10.3390/vaccines10020253. View

Bahsoun A, Fakih Y, Zareef R, Bitar F, Arabi M . Corticosteroids in COVID-19: pros and cons. Front Med (Lausanne). 2023; 10:1202504. PMC: 10461317. DOI: 10.3389/fmed.2023.1202504. View

Ward D, Gortz S, Thomson Ernst M, Nyboe Andersen N, Kjaer S, Hallas J . The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection. Eur Respir J. 2021; 59(4). PMC: 8435811. DOI: 10.1183/13993003.00769-2021. View

10.

Meikle A, TYLER F . Potency and duration of action of glucocorticoids. Effects of hydrocortisone, prednisone and dexamethasone on human pituitary-adrenal function. Am J Med. 1977; 63(2):200-7. DOI: 10.1016/0002-9343(77)90233-9. View

11.

Gabriel S, Michaud K . Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther. 2009; 11(3):229. PMC: 2714099. DOI: 10.1186/ar2669. View

12.

Rutherford M, Scott J, Karabayas M, Antonelou M, Gopaluni S, Gray D . Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study. Arthritis Rheumatol. 2021; 73(9):1713-1719. PMC: 8251299. DOI: 10.1002/art.41728. View

13.

Nanduri S, Pilishvili T, Derado G, Soe M, Dollard P, Wu H . Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant - National Healthcare Safety Network, March.... MMWR Morb Mortal Wkly Rep. 2021; 70(34):1163-1166. PMC: 8389386. DOI: 10.15585/mmwr.mm7034e3. View

14.

Tartof S, Slezak J, Fischer H, Hong V, Ackerson B, Ranasinghe O . Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study. Lancet. 2021; 398(10309):1407-1416. PMC: 8489881. DOI: 10.1016/S0140-6736(21)02183-8. View

15.

Altarawneh H, Chemaitelly H, Hasan M, Ayoub H, Qassim S, Almukdad S . Protection against the Omicron Variant from Previous SARS-CoV-2 Infection. N Engl J Med. 2022; 386(13):1288-1290. PMC: 8849180. DOI: 10.1056/NEJMc2200133. View

16.

Menachemi N, Dixon B, Wools-Kaloustian K, Yiannoutsos C, Halverson P . How Many SARS-CoV-2-Infected People Require Hospitalization? Using Random Sample Testing to Better Inform Preparedness Efforts. J Public Health Manag Pract. 2021; 27(3):246-250. DOI: 10.1097/PHH.0000000000001331. View

17.

Sparks J, Wallace Z, Seet A, Gianfrancesco M, Izadi Z, Hyrich K . Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry. Ann Rheum Dis. 2021; 80(9):1137-1146. PMC: 8172266. DOI: 10.1136/annrheumdis-2021-220418. View

18.

Saadoun D, Vieira M, Vautier M, Baraliakos X, Andreica I, da Silva J . SARS-CoV-2 outbreak in immune-mediated inflammatory diseases: the Euro-COVIMID multicentre cross-sectional study. Lancet Rheumatol. 2021; 3(7):e481-e488. PMC: 8081401. DOI: 10.1016/S2665-9913(21)00112-0. View

19.

Ludvigsson J, Axelrad J, Halfvarson J, Khalili H, Larsson E, Lochhead P . Inflammatory bowel disease and risk of severe COVID-19: A nationwide population-based cohort study in Sweden. United European Gastroenterol J. 2021; 9(2):177-192. PMC: 8014882. DOI: 10.1002/ueg2.12049. View

20.

Atzeni F, Masala I, Di Franco M, Sarzi-Puttini P . Infections in rheumatoid arthritis. Curr Opin Rheumatol. 2017; 29(4):323-330. DOI: 10.1097/BOR.0000000000000389. View