ACR Convergence 2021: Highlights from Days 4 & 5

Catch up on some of the latest updates to come from the fourth and fifth days of the 2021 ACR Convergence.

Immunosuppression Attenuates Antibody & Neutralization Titers in Patients with Chronic Inflammatory Disease Following SARS-CoV-2 Vaccination

Towards the beginning of the COVID-19 pandemic, it became clear that patients who were treated with immunosuppressive medications were at increased risk for severe infection. And while the development and rollout of the COVID-19 vaccines marked a turning point in the battle against the pandemic, their effectiveness in patients—specifically those with chronic inflammatory diseases (CID) being treated with immunosuppressive medications—was unknown.

That’s why a team of researchers began the COVID-19 Vaccine Responses in Patients with Autoimmune Disease study. To assess the immunogenicity and reactogenicity of the mRNA-based vaccines, blood was collected from 197 adults with CIDs and 53 immunocompetent patients before the initial shot and then 1-2 weeks after the second shot. From those blood samples, the number of serum anti-SARS-CoV-2 spike IgG+ binding and neutralizing antibody titers were collected.

Based on their analysis, researchers found a three-fold reduction in both anti-spike IgG titers and SARS-CoV-2 neutralization to the common variant when compared to immunocompetent patients.

When it came to the impact of specific immunosuppressive medications on patients’ responses, both B cell depletion therapies and glucocorticoids had the most severe impact as B cell depletion therapies were associated with a 36-fold reduction in humoral responses and glucocorticoids showed a 13-fold reduction. Similar results were seen among those being treated with Janus kinase inhibitors and antimetabolites as these patients also had lower numbers of antibody titers.

TNF inhibitors, IL-12/23 inhibitors, integrin inhibitors, and other targeted therapies, however, only modestly impacted antibody formation and neutralization.

These results show that there is lower COVID-19 vaccine-induced immunity among CID patients treated with immunosuppressive therapies, but there’s still more research to be done. In fact, the research team is now examining cross-variant neutralization, long-term antibody and neutralization titers, and T cell responses.

Socioeconomic Characteristics Associated with Electronic Health Care Utilization in an Urban Rheumatology Clinic During the COVID-19 Pandemic

Telemedicine and electronic patient portals became essential healthcare tools during the COVID-19 pandemic. But inequalities related to race, age, gender, and language may have prevented patients from seeking remote care. New research examined the socioeconomic barriers that contributed to the disproportionate use of telemedicine and electronic patient portals in an urban rheumatology clinic during the pandemic.

Characteristics such as age, sex, race, ethnicity, language, payment, and geography were studied using electronic health records of patients who visited the rheumatology clinic both pre-pandemic, between 3/1/2019 and 2/28/2020, and during the pandemic, between 4/1/2020 and 3/31/2021. Pre-pandemic, 1,503 patients completed 3,837 visits, all of them in person. During the pandemic, 1,442 patients completed 3.406 visits, with 40.6 percent of the visits in person, 20.4 percent conducted via telemedicine, and 29.1 percent conducted over the telephone.

During the pandemic, white-identifying patients were more than twice as likely to use telemedicine than Black/African American and American Indian/Alaska Native patients. English-preferring patients were 3.8x and 3.0x more likely to use telemedicine than Spanish-preferring and other non-English-preferring patients respectively. And those that used telemedicine were more likely to be female, younger age, live farther from the hospital, and carry commercial insurance.

The same is true for patients who used an electronic patient portal. English-preferring patients were 14.1x and 4.7x more likely to use an electronic patient portal than Spanish-preferring and other non-English-preferring patients respectively.

While the COVID-19 pandemic has compelled many rheumatology patients to use new, digital platforms to access healthcare, socioeconomic challenges and language barriers clearly identify inequality in telemedicine and electronic patient portal use. The study recommends these issues be carefully considered to provide the same service to all rheumatology patients.

Racial Disparities in Renal Outcomes over Time Among Hospitalized Children with SLE and Effects of Hospital Minority Composition

While care for pediatric systemic lupus erythematosus (SLE) patients has improved over time, racial and ethnic minorities still suffer worse renal outcomes compared to white patients. To provide equitable care, it’s critical to recognize these discrepancies and work towards possible solutions for closing the gap between pediatric SLE patient outcomes.

A recent study was conducted to examine ethnic and racial renal outcomes in pediatric SLE patients over a 13-year period. Patients 21 years old or younger with an ICD-9/10 hospital discharge diagnosis of SLE in the Pediatric Health Information System inpatient database were identified and adverse renal outcomes were closely monitored. Adverse renal outcomes included end-stage renal disease (ESRD) diagnosis code, dialysis producer code, and renal transplant.

Though adverse renal outcomes decreased over time among pediatric SLE patients, there were still notable incongruities between race and ethnic demographics. The study found Black children were more likely to have an adverse renal outcome compared to non-Hispanic whites. And incident hospitalization for adverse renal outcomes was more likely to occur in Black and Asian children compared to non-Hispanic white children.

Broader hospital demographic data were also reviewed. In hospitals with ≥50 percent Hispanic SLE patients, non-Hispanic white patients showed greater improvement than Black and Hispanic white patients. And in hospitals with ≥50 percent Black SLE patients, renal outcomes improved less over time among Black vs. non-Hispanic white pediatric patients and worsened among Hispanic white children.

Despite the overall response improvement during a 13-year time span, the study recommended racial and ethnic characteristics be closely considered to provide appropriate care for every pediatric SLE patient.