COVID-19 BREAKTHROUGH INFECTIONS IN VACCINATED PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES AND CONTROLS – DATA FROM TWO PROSPECTIVE COHORT STUDIES
Authors: Boekel L et al., Amsterdam, Netherlands
The primary objective of this prospective cohort study was to compare the incidence and severity of COVID-19 breakthrough infections with the SARS-CoV-2 between fully vaccinated patients with immune mediated inflammatory diseases (IMID) under treatment with immunosuppressants, and controls (IMID patients without immunosuppressants and healthy controls).
3207 IMID patients with immunosuppressants and 1810 controls (985 IMID patients without immunosuppressants and 825 healthy controls) were included. The incidence of COVID-19 breakthrough infections was comparable between patients with immunosuppressants (5%) and controls (5%). The absence of SARS-CoV-2 IgG antibodies after COVID-19 vaccination was independently associated with an increased incidence of breakthrough infections.
Hospitalization was required in 8 (5%) of 149 IMID patients with immunosuppressants and 5 (6%) of 86 controls with a COVID-19 breakthrough infection. Hospitalized cases were generally older and had more comorbidities compared with non-hospitalized cases. Hospitalization rates were significantly higher among IMID patients treated with anti-CD20 therapy compared to IMID patients using any other immunosuppressant (3 [23%] of 13 patients vs. 5 [4%] of 128 patients.
The incidence of COVID-19 breakthrough infections in vaccinated IMID patients with immunosuppressants was comparable to controls, and infections were mostly mild. Anti-CD20 therapy might increase patients’ susceptibility to severe COVID-19 breakthrough infections, but traditional risk factors also continue to have a critical contribution to the disease course of COVID-19. The absence of SARS-CoV-2 IgG antibodies after COVID-19 vaccination was independently associated with an increased incidence of breakthrough infections.
I therefore conclude to measure SARS-CoV-2 IgG AB after vaccination to recognize patients at risk with the possibility to protect them with passive immunization or virostatic drugs in case of a breakthrough infection.