COVID-19: Young adults with auto-immune diseases have different risks than their healthy counterparts

Having a diagnosis of rheumatic and musculoskeletal diseases (RMDs) entailed a higher chance of SARS- CoV-2 infection in comparison with healthy controls (HC). Also, young adults with RMDs and non-rheumatic auto- immune disease (nrAD) were significantly more prone to early mild adverse events (AE) after 1 or 2 vaccine doses than HC.

Dr Alessia Alunno (University of L’Aquila, Italy) pointed out that young adults with a chronic inflammatory disease, mainly those diagnosed at paediatric age, have long exposure to inflammation and immunosuppressive treatments, despite their younger age [1]. As for research on COVID-19, studies focusing on this population are currently lacking. “We tried to fill this knowledge gap,” Dr Alunno explained, presenting results that evaluated COVID-19 severity, breakthrough infections, vaccine-related AE, and post-vaccine flares in

patients aged 18 to 35. Data pertaining to the years 2021 and 2022 was collected from the international COVID-19 Vaccination in Autoimmune Diseases (COVAD) 1 and 2 questionnaires.

Included were 6,010 responders, among them 1,692 with RMDs, 400 nrAD, and 3,918 HC. The disease groups cohort consisted mainly of women at a rate of over 80%, while the proportion was lower in the HC (64%). At least 2 vaccine doses were administered to 75–83% of the cohort. The disease duration was around 7 years. “We observed that over 90% of patients with RMDs and only 20% with nrAD were exposed to immunosuppressants before vaccination,” Dr Alunno described.

Overall, 24–28% of the study cohort ever tested positive for SARS-CoV-2 infection. The infections were nearly always symptomatic, but hospitalisation, supplemental oxygen, or intensive care admission were rarely necessary. Looking at the likelihood of being infected pre- or post-vaccination, the results among the groups differed. Pre-vaccine infections were less frequent in patients with RMDs versus HC (OR 0.6; 95% CI 0.4–0.9) but similar in nrAD compared with HC. “This can be easily attributed to the straight shielding in people receiving immunosuppressants in the early phases of the pandemic,” Dr Alunno commented. In contrast, after vaccination, patients with RMDs were nearly 3 times more likely to be infected than HC (OR 2.7; 95% CI 2.1–3.5).

In terms of clinical manifestations, RMDs patients were more prone to arthralgia than HC, independent of the time of infection. Flares were self-reported post-infection by 5% (RMDs) and 1.5% (nrAD) and post-vaccination by 10% and 7%, respectively. Of note, only 41% (RMDs) and 27% (nrAD) of these prompted a change in dose or type of medication.

The likelihood for early mild AE after 1 or 2 vaccine doses was about twice as high for both disease groups compared with HC (OR 2.4; 95% CI 2.0–3.1 for RMDs and OR 2.0; 95% CI 1.4–2.9 for nrAD). Differences between groups for late, mild, or severe AE were not significant after any number of vaccine doses.

1. Alunno A, et al. COVID-19 severity, breakthrough infections and anti-SARS-COV-2 vaccine safety in young people with rheumatic and non-rheumatic autoimmune diseases: results from the COVAD1 and COVAD2 projects. LB0006, EULAR 2023, 31 May–3 June, Milan, Italy.

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Posted on 30 July 20238 April 2024