Patients with rheumatoid disease not at greater risk of Covid-19

Much has been learned about viral infections and vaccines in regards to autoimmune disease during the first year of the Covid-19 pandemic, the recent ISR Autumn Meeting was told. Prof Kevin Winthrop, Professor of Infectious Diseases and Ophthalmology at the School of Medicine, Portland Oregon, US, spoke on the topic of ‘Infection, autoimmune disease and 2020 – what we have learned?’.

In response to the question in his presentation title, Prof Winthrop stated: “We learnt a lot about viral infections and vaccines.” He said in the early weeks and months of the pandemic “the original question was – what about
our patients?”.

“Are rheumatic disease patients at higher risk for either getting Covid or having a bad outcome if they do get Covid,” Prof Winthrop asked. “So the answer to this question was, number one – no. There are several studies that show that patients with rheumatic disease are not at a higher risk of getting Covid and it’s probably because they are more aware and more adherent to social avoidance and mask-wearing and things like that. And there are studies and surveys that attest to that.

“There are also studies that attested to that most patients, with the exception of some subgroups, are probably at no higher risk of having a bad outcome if they get Covid.” He did note that there is analysis that suggests otherwise.“But I think overall, when you look at the data, the patients at risk are more sub-groups of patients and it is more related to underlining disease activity and the therapies they are using and the time they are infected.”

On the topic of vaccines, Prof Winthrop looked at research into the impact of disease-modifying anti-rheumatic drugs on vaccine immunogenicity. “What we have seen with Covid vaccination, really frankly, mirrors what we have seen with the rest of the vaccines [influenza, hepatitis B, HPV, etc],” said Prof Winthrop.

“The drugs that diminish these vaccine responses – the influenza responses, the pneumococcal responses, etc – are also the drugs where we have seen diminished responses in [the] SARS-Cov-2 [vaccine]. The most notable is rituximab and probably the second most notable is abatacept.” On vaccines in general, Prof Winthrop gave examples of data that show the positive benefit of people getting vaccinated from Covid-19, even if they already have had the virus.

“If you have been naturally infected, we have Senators and we have nay-sayers in the US who believe that people [who
have already had a Covid infection] shouldn’t get vaccinated,” he said. However, Prof Winthrop said
“there is great data that shows you should still get vaccinated”.