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. 2025 Feb 1;64(2):597-606.
doi: 10.1093/rheumatology/keae128.

Characteristics of and risk factors for COVID-19 breakthrough infections in idiopathic inflammatory myopathies: results from the COVAD study

Leonardo Santos Hoff  1 , Naveen Ravichandran  2 , Parikshit Sen  3 , Jessica Day  4   5   6 , Mrudula Joshi  7 , Arvind Nune  8 , Elena Nikiphorou  9   10 , Sreoshy Saha  11 , Ai Lyn Tan  12   13 , Samuel Katsuyuki Shinjo  14 , Nelly Ziade  15   16 , Tsvetelina Velikova  17 , Marcin Milchert  18 , Kshitij Jagtap  19 , Ioannis Parodis  20   21 , Abraham Edgar Gracia-Ramos  22 , Lorenzo Cavagna  23 , Masataka Kuwana  24 , Johannes Knitza  25 , Yi Ming Chen  26   27 , Ashima Makol  28 , Vishwesh Agarwal  29 , Aarat Patel  30 , John D Pauling  31   32 , Chris Wincup  33   34 , Bhupen Barman  35 , Erick Adrian Zamora Tehozol  36 , Jorge Rojas Serrano  37 , Ignacio García-De La Torre  38 , Iris J Colunga-Pedraza  39 , Javier Merayo-Chalico  40 , Okwara Celestine Chibuzo  41 , Wanruchada Katchamart  42 , Phonpen Akarawatcharangura Goo  43 , Russka Shumnalieva  44 , Lina El Kibbi  45 , Hussein Halabi  46 , Binit Vaidya  47 , Syahrul Sazliyana Shaharir  48 , A T M Tanveer Hasan  49 , Dzifa Dey  50 , Carlos Enrique Toro Gutiérrez  51 , Carlo V Caballero-Uribe  52 , James B Lilleker  53   54 , Babur Salim  55 , Tamer Gheita  56 , Tulika Chatterjee  57 , Oliver Distler  58 , Miguel A Saavedra  59 , Hector Chinoy  53   60   61 , Vikas Agarwal  2 , Rohit Aggarwal  62 , Latika Gupta  63   64   53 ; COVAD Study Group
Collaborators, Affiliations

Characteristics of and risk factors for COVID-19 breakthrough infections in idiopathic inflammatory myopathies: results from the COVAD study

Leonardo Santos Hoff et al. Rheumatology (Oxford). .

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.

Keywords: COVID-19; autoimmune diseases; breakthrough infection; hospitalization; idiopathic inflammatory myopathies.

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