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NYU Langone rheumatologists are presenting their discoveries at the annual American College of Rheumatology conference, which takes place from November 1 to November 9. The conference is being held virtually.
Topics presented include COVID-19 vaccine efficacy in people with lupus, fetal heart rate monitoring in high-risk pregnancies, and the relationship between whole-blood levels of hydroxychloroquine and cardiac risks.
“Our faculty continue to engage in cutting-edge research from bench to bedside, including a focus on very timely issues such as the approach to COVID-19 vaccination in our patients with autoimmune and rheumatic diseases,” says Jill P. Buyon, MD, the Sir Deryck and Lady Va Maughan Professor of Rheumatology and director of the Division of Rheumatology at NYU Langone. “Our clinicians and researchers are excited to share their work with the rheumatology community, and to open the doors for further study.”
NYU Langone’s Division of Rheumatology is ranked No. 8 in the nation by U.S. News & World Report. The division faculty is made up of more than 100 physicians and scientists, treating people with different forms of arthritis, as well as other diseases that affect joints and soft tissues.
At this year’s meeting, NYU Langone rheumatologists are presenting more than 40 posters, abstracts, summits, and scientific sessions. Additionally, three members of the faculty are receiving distinctions from the college. Some research highlights by ACR include the following.
Vaccine efficacy for various patient populations has been an important topic of study during the COVID-19 pandemic, with some patient populations—due to medications they take or autoimmune disorders—producing fewer antibodies relative to others in response to COVID-19 vaccinations. In this multi-ethnic and multi-racial study of people with systemic lupus erythematosus (SLE), 29 percent produced lower than normal IgG antibodies against the SARS-CoV-2 spike receptor-binding domain.
Peter M. Izmirly, MD, associate professor in the Department of Medicine at NYU Langone, led a team in observing 90 patients with SLE who received a full COVID-19 vaccination regimen. The study showed that a lower response to the vaccine was independently associated with being on any immunosuppressive agent, with the exception of antimalarials such as hydroxychloroquine.
“The importance of this study is that it supports previous data that have been seen from our group and others that show patients on certain immunosuppression have a blunted effect to the COVID-19 vaccine,” says Dr. Izmirly, the study’s co-author. “The results of this work are reassuring regarding the safety of initial vaccination and suggest further studies are needed to assess efficacy and safety of booster vaccination in patients with suboptimal responses to the standard vaccination regimen.”
A full paper on this abstract has been published in Arthritis and Rheumatology.
This research assessed accuracy of ambulatory fetal heart rate monitoring (FHRM) in mothers with anti-Ro/SSA antibodies, which can lead to high-risk pregnancies. Such antibodies may be present in women with rheumatic diseases like SLE and Sjogren’s syndrome or women who are clinically asymptomatic. Congenital heart block (CHB) occurs in about 2 percent of pregnancies in women with these antibodies and is a serious risk of fetal illness or death.
Thirty-seven mothers with anti-Ro/SSA antibodies were trained to perform FHRM to monitor for heart rhythm abnormalities. From weeks 17 to 25 of gestation, study participants completed FHRM 3 times daily, in addition to weekly or biweekly fetal echocardiograms. They shared detected sounds with the study’s data recording center, sending sounds they deemed abnormal to an on-call pediatric cardiologist who confirmed whether they were normal or, if abnormal, referred them for an emergency fetal echocardiogram.
Of the 3,360 FHRM audiotexts sent during the monitoring period, 39 prompted an immediate call with the cardiologist and 2 of these resulted in an emergency echocardiogram. In both cases there were premature atrial contractions, confirming the mother’s ability to use FHRM to accurately monitor for abnormalities.
“The goal of this study was to empower mothers to be able to detect an abnormality in their baby’s heart rate or rhythm that can be rapidly treated with the hope of reversal,” says study senior author Dr. Jill P. Buyon. “Our findings also hope to show that not all mothers with anti-SSA/Ro need intense monitoring, but only those who have very high levels of the antibodies.”
Hydroxychloroquine (HCQ) is an antimalarial drug commonly prescribed as a therapy for lupus. There is limited data to show if hydroxychloroquine use increases risk of QTc, a serious heart complication, in patients with chronic inflammatory diseases. In this prospective study of patients with SLE on HCQ, the authors found that there was no significant difference in mean QTc and whole-blood HCQ levels measured by high-performance liquid chromatography.
The 84 patients who met the ACR and Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) criteria for SLE and HCQ use had blood drawn and EKGs obtained, which showed no correlation between blood HCQ levels and QTc intervals. Many patients with chronic inflammatory diseases may have other conditions that increase their risk of cardiac instances, such as chronic kidney disease, older age, and underlying heart abnormalities. Researchers factored in variables like dosage amount and total blood levels of the drug, as well as chronic kidney disease and underlying heart abnormalities, and still found no correlation.
“Our study provides reassurance that hydroxychloroquine is not associated with QTc prolongation in patients with SLE and across different subsets of patients irrespective of blood level, dose prescribed, CKD, or underlying cardiac abnormalities,” says H. Michael Belmont, MD, professor in the Department of Medicine at NYU Langone and the study’s co-author. “More research needs to be done to understand the effects of the drug’s use in elderly SLE patients with underlying heart disease.”