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COVID Breakthrough Infections in Rheumatic Patients

Jack Cush, MD

Analysis of records from the Mass General Brigham healthcare system in the Boston area, shows that breakthrough infections (after receiving SARS-CoV-2 vaccines) in patients with systemic autoimmune rheumatic diseases (SARDs) are not uncommon, and may be severe or fatal.

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Not All Immunosuppression Alters Vaccine Immunogenicity

Jack Cush, MD

Chronic inflammatory disease (CID) patients are urged to receive the COVID-19 vaccines; but when a cohort of CID patients treated with immunosuppressive medications were given an mRNA-based SARS-CoV-2 vaccination, only those treated with glucocorticoids and B cell depleting therapies (B

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RheumNow Podcast – COVID Marching Amidst the Madness (8.27.2021)

Jack Cush, MD

We have a lot of news, information and approvals to review and discuss, though I need to begin with what's weighing heavily on my mind. After, we'll dive into what we learned this week.

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JAMA: In women with spontaneous abortions, COVID-19 vaccine exposure was not increased compared with women without Spont Ab (ongoing pregnancy). COVID-19 vax given to 8.0% ongoing pregnancy vs 8.6% spont ab (adj OR 1.02) https://t.co/wEeaMR98Mf

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Dr. John Cush RheumNow ( View Tweet)

MMWR: COVID-19–hospitalization rates in kids & adolescents rose 5-fold late June–mid-Aug 2021 (w/ rise of Delta variant). Hospitalization rates were 10 times higher among unvaccinated than fully vaccinated adolescents. https://t.co/Qt5lj3Ycxb

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Dr. John Cush RheumNow ( View Tweet)

In case you missed it— Booster Shots for Rheumatology Patients on Immunosuppressive Medications https://t.co/dIzrv3B12u https://t.co/nGIUNcqNTf

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Dr. John Cush RheumNow ( View Tweet)
Our latest @MassGenBrigham rheumatology COVID collaboration with @zach_wallace_md #preprint to share quickly. 16 confirmed breakthrough infections in rheumatic patients since vaccine EUAs in US. 15 symptomatic, 6 hospitalized, 2 deaths https://t.co/atixfBcEbn

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Jeffrey Sparks MD MMSc jeffsparks ( View Tweet)

Our @MassGenBrigham @zach_wallace_md rheum COVID paper on breakthrough infections is out now in ARD https://t.co/zOZqF0ecaG

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Jeffrey Sparks MD MMSc jeffsparks ( View Tweet)

MMWR: COVID-19–hospitalization rates in kids & adolescents rose 5-fold late June–mid-Aug 2021 (w/ rise of Delta variant). Hospitalization rates were 10 times higher among unvaccinated than fully vaccinated adolescents. https://t.co/Qt5lj3Ycxb https://t.co/p2e0KoiAXr

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Dr. John Cush RheumNow ( View Tweet)
Highly allergic can safely get the COVID Vax. Israeli study of 8102 pts w/ allergies recv Pfizer mRNA vax - 429 were highly allergic-->98% of the highly allergic had no allergic rxns, 1% mild allergic resp & 3 anaphylactic rxns Rx w/ EPI, none hospitalized https://t.co/ATYs5R5AQC https://t.co/owNEACH1pe

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Dr. John Cush RheumNow ( View Tweet)
Not All Immunosuppression Alters Vaccine Immunogenicity https://t.co/I9sShpMLBO https://t.co/oz9Qp1HM1e

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Dr. John Cush RheumNow ( View Tweet)
PhIII trial of Baricitinib vs placebo in hospitalized COVID-19 pts (91% steroids, 13% remdesivir). While no diff (28 vs 30%) in primary outcome (O2, ventilation, death). BARI had signif better Mortality @28d (8 vs 13%) & 60d (10 vs 15%) w/ no incr in VTE https://t.co/AjoRgEKW8G

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Dr. John Cush RheumNow ( View Tweet)

Lancet: 1276 Wuhan hosp COVID-19 pts studied at 6 & 12 mos. 68% & 49% had at least 1 COVID Sx at 6 & 12 mos. 12 mos sxs: SOB (30%), depression(26%), pain & mobility. Women had more fatigue/weak (OR 1.43), anx/depression (2·0), diffusion impairment (2·97) https://t.co/A8STTYiHq5 https://t.co/J4JoKFa00K

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Dr. John Cush RheumNow ( View Tweet)
Octave study examined COVID-19 Vax Ab responses in 600 immunocompromised-IMC (Cancer, IMID) pts. Compared to normals, fewer IMC seroconverted @4 wks (89 vs 100%). 40% of IMC had a low Ab resp; 11% of IMC had zero Ab response https://t.co/11VkeNKzvL

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Dr. John Cush RheumNow ( View Tweet)

NIAID will study COVID‐19 Booster Vaccine in Autoimmune Disease Non‐Responders (including MS, RA, SLE, Scleroderma,pemphigus); 20 sites, 600 pts (taking MTX, MMF or RTX) w/ poor resp to mRNA vax & recv 3rd booster vax. https://t.co/YwCvGnX21F https://t.co/th2WoRv1ng

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Dr. John Cush RheumNow ( View Tweet)

We've got another resource available on Cytokine Storm Management. Log in and download today. https://t.co/dTAzMVa6SB https://t.co/BvsZFxGrQl

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Dr. John Cush RheumNow ( View Tweet)
The current NEJM reports that the use of the Pfizer mRNA vaccine (BNT162b2) demonstrated a very low risk for certain serious adverse events, including the risk of myocarditis (1 to 5 events per 100,000 persons). https://t.co/CT4dQK9XlH https://t.co/enddiHtX1G

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Dr. John Cush RheumNow ( View Tweet)
Si @DGlaucomflecken es el mejor se dice y ya está https://t.co/QzPyIe5gAA
Raruniente Raruniiente ( View Tweet)
New podcast available for download! COVID Marching Amidst the Madness https://t.co/xYzkw3zGRt https://t.co/gv45nVk9v5

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Dr. John Cush RheumNow ( View Tweet)
ACR Guidance on Timing of 3rd Dose Booster with Immunomodulatory Drugs https://t.co/XO4DPXwGQi https://t.co/S9E3yENfDF

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Dr. John Cush RheumNow ( View Tweet)
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