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. 2023 Jul 18:38:100843.
doi: 10.1016/j.lanwpc.2023.100843. eCollection 2023 Sep.

Omicron variant infection in inflammatory rheumatological conditions - outcomes from a COVID-19 naive population in Aotearoa New Zealand

Jonathon Brooks  1 , Anna Montgomery  2 , Nicola Dalbeth  3   4 , Mark Sapsford  1 , Rachel Ngan Kee  5 , Amy Cooper  5 , Vicki Quincey  6 , Suleman Bhana  7 , Monique Gore-Massy  8 , Jonathan Hausmann  9   10 , Jean Liew  11 , Pedro M Machado  12   13   14 , Paul Sufka  15 , Emily Sirotich  16 , Philip Robinson  17   18 , Zachary Wallace  19 , Jinoos Yazdany  2 , Rebecca Grainger  5   20
Affiliations

Omicron variant infection in inflammatory rheumatological conditions - outcomes from a COVID-19 naive population in Aotearoa New Zealand

Jonathon Brooks et al. Lancet Reg Health West Pac. .

Abstract

Background: Due to geographic isolation and border controls Aotearoa New Zealand (AoNZ) attained high levels of population coronavirus disease-19 (COVID-19) vaccination before widespread transmission of COVID-19. We describe outcomes of SARS-CoV-2 infection (Omicron variant) in people with inflammatory rheumatic diseases in this unique setting.

Methods: This observational study included people with inflammatory rheumatic disease and SARS-CoV-2 infection in AoNZ between 1 February and 30 April 2022. Data were collected via the Global Rheumatology Alliance Registry including demographic and rheumatic disease characteristics, and COVID-19 vaccination status and outcomes. Multivariable logistic regression was used to explore associations of demographic and clinical factors with COVID-19 hospitalisation and death.

Findings: Of the 1599 cases included, 96% were from three hospitals that systematically identified people with inflammatory rheumatic disease and COVID-19. At time of COVID-19, 1513 cases (94.6%) had received at least two COVID-19 vaccinations. Hospitalisation occurred for 104 (6.5%) cases and 10 (0.6%) patients died. Lower frequency of hospitalisation was seen in cases who had received at least two vaccinations (5.9%), compared to the unvaccinated (20.6%) or those with a single vaccine dose (10.7%). In multivariable adjusted models, people with gout or connective tissue diseases (CTD) had increased risk of the combined outcome of hospitalisation/death, compared to people with inflammatory arthritis. Glucocorticoid and rituximab use were associated with increased rates of hospitalisation/death. All patients who died had three or more co-morbidities or were over 60 years old.

Interpretation: In this cohort with inflammatory rheumatic diseases and high vaccination rates, severe outcomes from SARS-CoV-2 Omicron variant were relatively infrequent. The outcome of Omicron variant infection among vaccinated but SARS-CoV-2 infection-naive people with inflammatory rheumatic disease without other known risk factors were favourable.

Funding: Financial support from the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) included management of COVID-19 Global Rheumatology Alliance funds.

Keywords: COVID-19; Outcomes; Rheumatic disease; SARS-CoV-2.

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Conflict of interest statement

JB has no conflicts of interest to declare. AM has no conflicts of interest to declare. ND reports personal fees from AstraZeneca, Dyve Biosciences, Horizon, Selecta, Arthrosi, JW Pharmaceutical Corporation, PK Med, LG Chem, JPI, PTC Therapeutics, Protalix, Unlocked Labs, Hikma outside the submitted work. MS reports speaking fees from Novartis. RNK has no conflicts of interest to declare. AC has no conflicts of interest to declare. VQ has no conflicts of interest to declare. SB reports consulting fees from AbbVie, Horizon, Novartis, and Pfizer. SB is an employee of Pfizer, Inc. MGM has no conflicts of interest to declare. JH has research grants from the Rheumatology Research Foundation and the Childhood Arthritis and Rheumatology Research Foundation. JH reports speaking fees from Novartis, Fresenius Kabi, Pfizer, and Biogen. JL has a research grant from Pfizer. PMM has received consulting/speaker's fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartisg, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, and is supported by the National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BRC). PS reports an honorarium from the COVID-19 Global Rheumatology Alliance. ES reports grants from the COVID-19 Global Rheumatology Alliance, Canada's drug and health technology agency, the Canadian Institute for Health Research, and McMaster University. ES reports honoraria from the Canadian Rheumatology Association and the Canadian Arthritis Patient's Alliance. PR was unable to report his conflicts of interest as he is deceased. ZW reports research grants from BMS, Sanofi, the National Institute of Health and the Rheumatology Research Foundation. ZW reports royalties from the IgG4 symptom severity score and consulting fees from Sanofi, Horizon, MedPace, Viela Bio, Zenas, and Shionogi. ZW reports participation on data monitoring boards for Sanofi, Horizon, Novartis, Visterra/Otsuka, and Shinogi. JY is supported by NIH/NIAMS K24 AR07534 and AHRQ R01HS028024. She has received research grants from Gilead, Aurinia, BMS Foundation and Astra Zeneca and performed consultation for Astra Zeneca, Pfizer, and Aurinia. RG reports personal and/or speaking fees from AbbVie, Janssen, Novartis, Pfizer, Cornerstones and travel assistance from Pfizer (all < $10,000). The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the American College of Rheumatology (ACR), the European Alliance of Associations for Rheumatology (EULAR), the (UK) National Health Service (NHS), the National Institute for Health Research (NIHR), or the (UK) Department of Health, or any other organisation.

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