POS1212 SARS-CoV-2 INFECTION AMONG PATIENTS WITH BEHÇET’S SYNDROME
Authors: I. Mattioli, A. Bettiol, M. L. Urban, E. Silvestri, D. Malandrino, A. Palermo, F. Fagni, D. Prisco, G. Emmi
Journal: Annals of the Rheumatic Diseases (2021)

Background: Studies on SARS-Cov-2 in Behçet’s syndrome (BS) patients are limited to two small case series from European centres.[1,2] Objectives: We aimed to assess the prevalence of SARS-CoV-2 infection among Italian BS patients referring to Careggi University Hospital (Florence, Italy) and to evaluate the possible association between BS disease activity and treatment and the risk of Sars-CoV-2 infection among patients with BS. Methods: A survey was conducted among 335 subjects diagnosed with BS and followed at Careggi University Hospital. Moreover, we conducted a case-control study. Cases were described in term of SARS-CoV-2 manifestation and prognosis, changes in disease activity, and in pharmacological therapies. Sars-CoV-2 negative controls matched 1:3 by sex, age and disease duration ± 5 years were randomly selected. Results: Out of 335 BS patients, 12 declared to have/have had SARS-CoV-2 infection (3.6%). Eight were females (median age of 40 years), with a median duration of BS disease of 6 years; five had active disease. Nine patients reported fever, 9 myalgia/arthralgia, 5 gastrointestinal symptoms, 5 anosmia/ageusia, 5 cough, 3 headache, 3 fatigue, 2 breathlessness, panic attacks and dizziness (one each). Before infection, patients were treated with corticosteroids, colchicine, hydroxychloroquine (HCQ), traditional DMARDs [azathioprine (n patients = 4), methotrexate (n=1)], and biologics DMARDs [adalimumab (n=6), infliximab (n=2), secukinumab (n=1), and canakinumab (n=1)]. Therapy was suspended for a median time of 33 days in 9patients and resumed after a median time of 5 days from negativation. Regarding SARS-CoV-2 treatment, most patients started or increased corticosteroids, whereas heparin and antipyretic drugs were used in 4 and 5 patients, respectively. Cases were comparable to controls in terms of disease manifestations, activity, and immunomodulating therapy, with the only exception of corticosteroids, whose daily dose was significantly higher in cases (Table 1). Conclusion: Prevalence of SARS-CoV-2 infection among Italian BS patients is 3.6%, similarly to the Italian general population (4.2%). Disease activity at time of infection was not associated with an increased risk of SARS-CoV-2 infection. Most patients interrupted biologic DMARDs. However, use of DMARDs, seemed not to be associated with an increased risk of SARS-CoV-2 infection, while higher doses of corticosteroids resulted to be more common among patients with SARS-CoV-2 infection as compared to controls. No patient required hospitalization or died. Our experience shows encouraging data about BS patients who do not appear be at greater risk of SARS-CoV-2 infection or complications than the general population. References: [1]Espinosa et al. COVID-19 and Behçet’s disease: clinical case series. Ann Rheum Dis. 2020 [2]Yurttaş et al. Characteristics and outcomes of Behçet’s syndrome patients with Coronavirus Disease 2019: a case series of 10 patients. IEM. 2020 [3] http://www.salute.gov.it Table 1. Features of SARS-CoV-2+ cases and matched controls 12 SARS-CoV-2+ CASES PRE-INFECTION 12 SARS-CoV-2+ CASES POST-INFECTION 36 CONTROLS p-value* Female sex 8 (66.7%) 24 (66.7%) Matching variable Median age 40 (IQR 31-45) 40 (IQR 32-44) Matching variable Median disease duration 6 (IQR 5-9) 6 (IQR 3-8) Matching variable Active disease (BDCAF≥1) 5 (41.7%) 4 had disease relapse 24 (66.7%) 0.176 Immunomodulating therapy Corticosteroids – 8 (66.7%) 8 (66.7%) 12 (33.3%) 0.088 Median dosage (IQR) 5 (IQR 0-12.5) 6 (IQR 0-15) 0 (IQR 0-2.5) 0.010 Colchicine 2 (16.7%) Continued 11 (30.6%) 0.469 HCQ 1 (8.3%) Continued 1 (2.8%) 0.441 Traditional DMARDs 5 (41.7%) 1 interrupted 8 (22.2%) 0.263 Biologic DMARDs 10 (83.3%) 8 interrupted 27 (75%) 0.705 Disease involvement Mucocutaneous 5 (41.7%) 12 (33.3%) 0.731 Articular 5 (41.7%) 4 worsened 17 (47.2%) 1.000 Ocular 0 2 (5.6%) n.a. Vascular 0 0 n.a. Neurological 3 (25%) 8 (22.2%) 1.000 Gastrointestinal 2 (16.7%) 1 worsened 6 (16.7%) 1.000 *p-value from Fisher exact test for unpaired data between first columns vs third columns Disclosure of Interests: None declared.