Characteristics of and risk factors for COVID-19 breakthrough infections in idiopathic inflammatory myopathies: results from the COVAD study
Authors: Hoff Leonardo Santos , Ravichandran Naveen , Sen Parikshit , Day Jessica , Joshi Mrudula , Nune Arvind , Nikiphorou Elena , Saha Sreoshy , Tan Ai Lyn , Shinjo Samuel Katsuyuki , Ziade Nelly , Velikova Tsvetelina , Milchert Marcin , Jagtap Kshitij , Parodis Ioannis , Gracia-Ramos Abraham Edgar , Cavagna Lorenzo , Kuwana Masataka , Knitza Johannes , Chen Yi Ming , Makol Ashima , Agarwal Vishwesh , Patel Aarat , Pauling John D , Wincup Chris , Barman Bhupen , Tehozol Erick Adrian Zamora , Serrano Jorge Rojas , Torre Ignacio García-De La , Colunga-Pedraza Iris J , Merayo-Chalico Javier , Chibuzo Okwara Celestine , Katchamart Wanruchada , Goo Phonpen Akarawatcharangura , Shumnalieva Russka , El Kibbi Lina , Halabi Hussein , Vaidya Binit , Shaharir Syahrul Sazliyana , Hasan A T M Tanveer , Dey Dzifa , Gutiérrez Carlos Enrique Toro , Caballero-Uribe Carlo V , Lilleker James B , Salim Babur , Gheita Tamer , Chatterjee Tulika , Distler Oliver , Saavedra Miguel A , Chinoy Hector , Agarwal Vikas , Aggarwal Rohit , Gupta Latika ,   COVAD Study Group, Singh Yogesh Preet , Ranjan Rajiv , Jain Avinash , Pandya Sapan C , Pilania Rakesh Kumar , Sharma Aman , M Manesh Manoj , Gupta Vikas , Kavadichanda Chengappa G , Patro Pradeepta Sekhar , Ajmani Sajal , Phatak Sanat , Goswami Rudra Prosad , Chowdhury Abhra Chandra , Mathew Ashish Jacob , Shenoy Padnamabha , Asranna Ajay , Bommakanti Keerthi Talari , Shukla Anuj , Pande Arunkumar R , Gaur Prithvi Sanjeevkumar , Mamadapur Mahabaleshwar , Ghodke Akanksha , Chandwar Kunal , Kadam Esha , Fazal Zoha Zahid , Kardeş Sinan , Cansu Döndü Üsküdar , Yıldırım Reşit , Gasparyan Armen Yuri , Giannini Margherita , Maurier François , Campagne Julien , Meyer Alain , Del Papa Nicoletta , Sambataro Gianluca , Fabiola Atzeni , Govoni Marcello , Parisi Simone , Bocci Elena Bartoloni , Sebastiani Gian Domenico , Fusaro Enrico , Sebastiani Marco , Quartuccio Luca , Franceschini Franco , Sainaghi Pier Paolo , Orsolini Giovanni , De Angelis Rossella , Danielli Maria Giovanna , Venerito Vincenzo , Grignaschi Silvia , Giollo Alessandro , Andreoli Laura , Lini Daniele , Alluno Alessia , Iannone Florenzo , Fornaro Marco , Traboco Lisa S , Wibowo Suryo Anggoro Kusumo , Loarce-Martos Jesús , Prieto-González Sergio , Aranega Raquel , Yoshida Akira , Nakashima Ran , Sato Shinji , Kimura Naoki , Kaneko Yuko , Gono Takahisa , Tomaras Stylianos , Proft Fabian Nikolai , Holzer Marie-Therese , Gromova Margarita Aleksandrovna , Aharonov Mr Or , Nagy-Vincze Melinda , Griger Zoltán , Schrieber Karen , Hmamouchi Ihsane , El bouchti Pr Imane , Baba Zineb , Ima-Edomwonyi Uyi , Dedeke Ibukunoluwa , Airenakho Emorinken , Madu Nwankwo Henry , Yerima Abubakar , Olaosebikan Hakeem , Becky A , Koussougbo Ouma Devi , Palalane Elisa , Langguth Daman , Limaye Vidya , Needham Merrilee , Srivastav Nilesh , Hudson Marie , Landon-Cardinal Océane , Zuleta Wilmer Gerardo Rojas , Arbeláez Álvaro , Cajas Javier , Silva José António Pereira , Fonseca João Eurico , Zimba Olena , Bohdana Doskaliuk , So Ho , Ugarte-Gil Manuel Francisco , Chinchay Lyn , Bernaola José Proaño , Pimentel Victorio , Fathi Hanan Mohamed , Mohammed Reem Hamdy A , Harifi Ghita , Fuentes-Silva Yurilís , Cabriza Karoll , Losanto Jonathan , Colaman Nelly , Cachafeiro-Vilar Antonio , Bautista Generoso Guerra , Ho Enrique Julio Giraldo , González Raúl , Nunez Lilith Stange , Cristian Vergara M , Báez Jossiell Then , Alonzo Hugo , Pastelin Carlos Benito Santiago , Salinas Rodrigo García , Obiols Alejandro Quiñónez , Chávez Nilmo , Ordóñez Andrea Bran , Argueta Sandra , Quijivix Daniel , Llerena Gil Alberto Reyes , Sierra-Zorita Radames , Arrieta Dina , Hidalgo Eduardo Romero , Saenz Ricardo , Morales Idania Escalante M , Roberto , Calapaqui Wendy , Quezada Ivonne , Arredondo Gabriela 
Published: March 2024

Abstract

Objectives
The objective of this study was to explore the prevalence, characteristics and risk factors of COVID-19 breakthrough infections (BIs) in idiopathic inflammatory myopathies (IIMs) using data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

Methods
A validated patient self-reporting e-survey was circulated by the COVAD study group to collect data on COVID-19 infection and vaccination in 2022. BIs were defined as COVID-19 occurring ≥14 days after two vaccine doses. We compared BI characteristics and severity among patients with IIMs, patients with other autoimmune rheumatic and non-rheumatic diseases (AIRD, nrAID), and healthy controls (HCs). Multivariable Cox regression models were used to assess the risk factors for BI, severe BI ,and hospitalizations among patients with IIMs.

Results
Among the 9449 included responses, BIs occurred in 1447 respondents (15.3%). The median age was 44 years [interquartile range (IQR) 21], 77.4% were female, and 182 BIs (12.9%) occurred among the 1406 patients with IIMs. Multivariable Cox regression among the data for patients with IIMs showed increasing age to be a protective factor for BIs [hazard ratio (HR) = 0.98, 95% CI = 0.97–0.99], and HCQ and SSZ use were risk factors (HR = 1.81, 95% CI = 1.24–2.64, and HR = 3.79, 95% CI = 1.69–8.42, respectively). Glucocorticoid use was a risk factor for a severe BI (HR = 3.61, 95% CI = 1.09–11.8). Non-white ethnicity (HR = 2.61, 95% CI = 1.03–6.59) was a risk factor for hospitalization. Compared with other groups, patients with IIMs required more supplemental oxygen therapy (IIMs = 6.0% vs AIRDs = 1.8%, nrAIDs = 2.2% and HCs = 0.9%), intensive care unit admission (IIMs = 2.2% vs AIRDs = 0.6%, nrAIDs and HCs = 0%), advanced treatment with antiviral or monoclonal antibodies (IIMs = 34.1% vs AIRDs = 25.8%, nrAIDs = 14.6% and HCs = 12.8%) and had more hospitalization (IIMs = 7.7% vs AIRDs = 4.6%, nrAIDs = 1.1% and HCs = 1.5%).

Conclusion
Patients with IIMs are susceptible to severe COVID-19 BIs. Age and immunosuppressive treatments were related to the risk of BIs.