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. 2025 Jun 24;12(1):e003008.
doi: 10.1136/bmjresp-2024-003008.

Association of vaccination status and immunosuppression with mortality of SARS-CoV-2 infection in patients with fibrotic interstitial lung disease

Kathryn Donohoe  1 , Kerri A Johannson  2   3 , Helene Manganas  4 , Veronica Marcoux  5 , Christopher J Ryerson  6
Affiliations

Association of vaccination status and immunosuppression with mortality of SARS-CoV-2 infection in patients with fibrotic interstitial lung disease

Kathryn Donohoe et al. BMJ Open Respir Res. .

Abstract

Background: There are limited data exploring the outcome following SARS-CoV-2 infection in fibrotic interstitial lung disease (fILD). Our goal was to determine the association of vaccination for SARS-CoV-2 with both SARS-CoV-2 infection and subsequent 90-day mortality in fILD. Our second objective was to determine the association of immunosuppressive use with both SARS-CoV-2 infection and subsequent 90-day mortality in fILD.

Methods: Patients with fILD enrolled in the Canadian Registry for Pulmonary Fibrosis with comprehensive access to data on SARS-CoV-2 vaccination and PCR-confirmed infection were included. Associations of vaccination status and current immunosuppressant use with SARS-CoV-2 infection and subsequent 90-day mortality were tested using Fisher's exact test and subsequently multivariable logistic regression adjusting for age, sex, pre-identified comorbidities, forced vital capacity and diffusing capacity of the lung for carbon monoxide.

Results: Of 1452 total patients with fILD, 138 tested positive for SARS-CoV-2. On adjusted analysis, vaccination for SARS-CoV-2 was associated with a 60% reduction in the odds of infection (OR 0.40, 95% CI 0.24 to 0.67 p<0.001) and a 97% reduction in the odds of 90-day mortality following infection (OR 0.03, 95% CI 0.0007 to 0.26, p=0.01). SARS-CoV-2 was diagnosed in 13% of patients on an immunosuppressant and 9% of those not (OR 1.4, 95% CI 1.0 to 2.1, p=0.04). Immunosuppressant use was not associated with 90-day mortality after SARS-CoV-2 infection on adjusted analysis.

Conclusion: In patients with fILD, vaccination against SARS-CoV-2 was associated with decreased frequency of SARS-CoV-2 infection and subsequent 90-day mortality, while current use of immunosuppressive medication was associated with risk of infection but only a trend for subsequent 90-day mortality.

Keywords: COVID-19; Idiopathic Pulmonary Fibrosis; Interstitial Fibrosis.

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Conflict of interest statement

Competing interests: KDonohoe reports no conflicts of interest relevant to this manuscript. KAJ reports personal fees from Boehringer Ingelheim and Abbvie, and consulting grants from Boehringer Ingelheim, Pliant Therapeutics, Hoffman-La Roche and Brainomix. KJ reports grants from the University of Calgary Foundation and Three Lakes Foundation. HM reports personal fees from Boehringer Ingelheim Canada and grants from Boehringer Ingelheim Canada, BMS, Galapagos and Endeavor Biomedicines Inc. VM reports consulting fees from Boehringer Ingelheim Canada and Hoffman-La Roche, grants from Astra Zeneca, Boehringer Ingelheim, the University of Saskatchewan and the Respiratory Research Center-Saskatchewan. CJR reports personal fees from Boehringer Ingelheim and consulting fees from Boehringer Ingelheim, Pliant Therapeutics, Astra Zeneca, Trevi Therapeutics and Veracyte. CJR reports grants from Boehringer Ingelheim.

Figures

Figure 1
Figure 1. Survival stratified by vaccination and immunosuppression status in fILD.
Figure 2
Figure 2. SARS-CoV-2 infection and 90-day mortality in fILD.
See this image and copyright information in PMC

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References

    1. Collard HR, Ryerson CJ, Corte TJ, et al. Acute Exacerbation of Idiopathic Pulmonary Fibrosis. An International Working Group Report. Am J Respir Crit Care Med. 2016;194:265–75. doi: 10.1164/rccm.201604-0801CI. - DOI - PubMed
    1. Drake TM, Docherty AB, Harrison EM, et al. Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study. Am J Respir Crit Care Med. 2020;202:1656–65. doi: 10.1164/rccm.202007-2794OC. - DOI - PMC - PubMed
    1. Gallay L, Uzunhan Y, Borie R, et al. Risk Factors for Mortality after COVID-19 in Patients with Preexisting Interstitial Lung Disease. Am J Respir Crit Care Med. 2021;203:245–9. doi: 10.1164/rccm.202007-2638LE. - DOI - PMC - PubMed
    1. Shao C, Shi Y, Chen R, et al. Risk factors associated with COVID-19 pneumonia in Chinese patients with pre-existing interstitial lung disease during the SARS-CoV-2 pandemic. J Med Virol. 2023;95:e29098. doi: 10.1002/jmv.29098. - DOI - PubMed
    1. Beltramo G, Cottenet J, Mariet A-S, et al. Chronic respiratory diseases are predictors of severe outcome in COVID-19 hospitalised patients: a nationwide study. Eur Respir J. 2021;58:2004474. doi: 10.1183/13993003.04474-2020. - DOI - PMC - PubMed

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