P057 What is the course of SARS-CoV-2 infection in people with autoimmune conditions on immunomodulators in comparison to people without autoimmune disease?
Authors: Biddle Kathryn , Koushesh Soraya , Clark David , Krishna Sanjeev , Webb Shannon , Patel Kamal , Pollok Richard , Sofat Nidhi 
Published: April 2021

Background/Aims 

The pathogenesis and outcomes of COVID-19 in patients with autoimmune disease remains poorly understood. We aimed to evaluate clinical features and antibody mediated immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in subjects with autoimmune disease, compared to those without.

Methods 

Patients who developed COVID-19 were identified through the audit department/clinician identification. In total, there were 48 subjects with autoimmune disease and confirmed COVID-19. Of these patients, 6 had sadly died. In recruited patients, clinical data regarding COVID-19 symptoms, treatment and outcomes were collected. Blood was taken for quantitative serology testing against SARS-CoV-2 using the Mologic test kit. A binary logistic regression was used to compare serology results in subjects with and without autoimmune diagnoses.

Results 

Our sample included 103 participants. 26 subjects with autoimmune disease and confirmed COVID-19 were recruited, the most common diagnoses being rheumatoid arthritis (27%), psoriatic arthritis (19%) and inflammatory bowel disease (15%). 21 of 28 participants were on immunomodulatory medications including 16 on conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), four on biologic DMARDs and one on tacrolimus. We age- and gender-matched these subjects to 26 without autoimmune disease with confirmed SARS-CoV-2 infection. 17 further subjects reported viral-symptoms during the COVID-19 pandemic but had negative serology. 30 subjects had rheumatic conditions but denied symptoms suggestive of COVID-19. 4 of the asymptomatic patients tested positive for COVID-19 on serology. 23 stored serum samples, obtained before 2019, were all negative for antibodies against SARS-CoV-2. In patients with confirmed COVID-19, clinical features and serology were compared in those with and without autoimmune disease. Logistic regression showed a significant impact of COVID-19 severity on antibody titres in people with and without autoimmune disease (p = 0.003 and &lt;0.001 respectively). In both mild and severe disease, autoimmunity had no effect on antibody titres (p = 0.253 and 0.119 respectively).

Conclusion 

People with and without autoimmune disease presented with similar symptoms of COVID-19. In our sample, subjects with autoimmune disease were less likely to be hospitalised or require respiratory support. Serology revealed no difference in antibody titres against SARS-CoV-2 in participants with and without autoimmune disease. P057 Table 1:A comparison of the clinical features of COVID-19 in patients with and without autoimmune diseaseParticipants with autoimmune disease (n = 26)Participants without autoimmune disease (n = 26)Average age5855Male to female ratio10:1610:16EthnicityWhite 50%Black 23%Asian 27%White 62%Black 12%Asian 15%Other 4%Co-morbiditiesHypertension 35%Diabetes 19%Obstructive lung disease 12%Interstitial lung disease 12%Ischaemic heart disease 4%Hypertension 23%Diabetes 20%Obstructive lung disease 15%Interstitial lung disease 0%Ischaemic heart disease 12%Most common symptoms of COVID-19 infectionMalaise 73%Cough 73%Fever 70%Dyspnoea 62%Malaise 84%Cough 85%Fever 77%Dyspnoea 65%Level of care required during acute illnessHome 39%Ward 57%Intensive Care Unit 4%Home 27%Ward 58%High Dependency Unit 15%Respiratory supportNone 65%Oxygen therapy 30%Non-invasive ventilation 0%Invasive ventilation 5%None 46%Oxygen therapy 38%Non-invasive ventilation 15%Invasive ventilation 0%

Disclosure 

K. Biddle: None. S. Koushesh: None. D. Clark: None. S. Krishna: None. S. Webb: None. K. Patel: None. R. Pollok: None. N. Sofat: None.