COVID-19 and protection of vaccination in patients with systemic sclerosis–associated interstitial lung disease. Issue 2 (June 2023)

• Record Type: Journal Article
• Authors: Panopoulos, Stylianos; Tzilas, Vasilios; Bournia, Vasiliki-Kalliopi; Karamanakos, Anastasios; Laskari, Katerina; Bouros, Demosthenes; Tektonidou, Maria; Sfikakis, Petros P.
• Is Part Of: Journal of scleroderma and related disorders. Volume 8:Issue 2(2023)
• Page Start: 113
• Page End: 119
• Publication Date: 2023-06
• Subjects: Systemic sclerosis -- interstitial lung disease -- COVID-19 -- vaccination -- outcomes; Scleroderma (Disease) -- Periodicals; Systemic scleroderma -- Periodicals; Fibrosis -- Periodicals; 616.544
• DOI: 10.1177/23971983221143252
• Languages: English
• ISSNs: 2397-1983

Abstract

Objectives: Data on COVID-19 in patients with interstitial lung disease are scarce and whether SARS-CoV-2 may trigger interstitial lung disease progression remains unknown. We aimed to analyze outcomes of COVID-19 in patients with systemic sclerosis–associated interstitial lung disease, including possible thoracic radiographic progression. Patients and Methods: All 43 patients with systemic sclerosis–associated interstitial lung disease followed in our center (mean ± SD, 55.2 ± 11.6 years, 36 female) with confirmed SARS-CoV2 infection up to 1 September 2022 were analyzed. Individual interstitial lung disease extent on high resolution CT (HRCT) performed before (up to 3 months) and after COVID-19 (2–5 months) was compared. Results: At SARS-CoV-2 infection, 9/43 patients were unvaccinated, whereas 5, 26, and 3 had received 2, 3, or 4 doses of an mRNA vaccine, respectively. Thirty-one patients were either on monotherapy with immunosuppressives (mycophenolate, n = 7; cyclophosphamide, n = 2; methotrexate, n = 10; tocilizumab, n = 7; rituximab, n = 1; etanercept, n = 1), or their combinations ( n = 3). Eight patients (20%), of whom four unvaccinated, required hospitalization for pneumonia and three (7%) died of acute respiratory failure ( n = 2, both unvaccinated) or cardiac arrest. Lack of vaccination was the only independent predictor for hospitalization (OR = 7.98, 95% CI: 1.25–51.09) and marginally for death (OR = 32.7, 95% CI: 0.97–1110.98), regardless of the presence of diffuse systemic sclerosis, interstitial lung disease extent greater than 20% or immunosuppressive treatment. In 22 patients with available HRCT pairs (vaccinated = 20), the interstitial lung disease extent before COVID-19 (20.4%± 17.8%) remained unchanged (22.4% ± 18.5%) in all but one patient. Conclusion: SARS-CoV-2 vaccination is of outmost importance for every systemic sclerosis patient with interstitial lung disease. COVID-19 does not seem to promote progression of systemic sclerosis–associated interstitial lung disease in vaccinated patients, but further studies are warranted.