Hoff L.S.Ravichandran N.Sen P.Day J.Joshi M.Nune A.Nikiphorou E.Saha S.Tan A.L.Shinjo S.K.Ziade N.Velikova T.Milchert M.Jagtap K.Parodis I.Gracia-Ramos A.E.Cavagna L.Kuwana M.Knitza J.Chen Y.M.Makol A.Agarwal V.Patel A.Pauling J.D.Wincup C.Barman B.Tehozol E.A.Z.Serrano J.R.Torre I.G.D.L.Colunga-Pedraza I.J.Merayo-Chalico J.Chibuzo O.C.Katchamart W.Goo P.A.Shumnalieva R.El Kibbi L.Halabi H.Vaidya B.Shaharir S.S.Hasan A.T.M.T.Dey D.Gutiérrez C.E.T.Caballero-Uribe C.V.Lilleker J.B.Salim B.Gheita T.Chatterjee T.Distler O.Saavedra M.A.Chinoy H.Agarwal V.Aggarwal R.Gupta L.Mahidol University2025-02-172025-02-172025-02-01Rheumatology (Oxford, England) Vol.64 No.2 (2025) , 597-606https://repository.li.mahidol.ac.th/handle/20.500.14594/105337OBJECTIVES: The objective of this study was to explore the prevalence, characteristics and risk factors of COVID-19 breakthrough infections (BIs) in idiopathic inflammatory myopathies (IIMs) using data from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. METHODS: A validated patient self-reporting e-survey was circulated by the COVAD study group to collect data on COVID-19 infection and vaccination in 2022. BIs were defined as COVID-19 occurring ≥14 days after two vaccine doses. We compared BI characteristics and severity among patients with IIMs, patients with other autoimmune rheumatic and non-rheumatic diseases (AIRD, nrAID), and healthy controls (HCs). Multivariable Cox regression models were used to assess the risk factors for BI, severe BI ,and hospitalizations among patients with IIMs. RESULTS: Among the 9449 included responses, BIs occurred in 1447 respondents (15.3%). The median age was 44 years [interquartile range (IQR) 21], 77.4% were female, and 182 BIs (12.9%) occurred among the 1406 patients with IIMs. Multivariable Cox regression among the data for patients with IIMs showed increasing age to be a protective factor for BIs [hazard ratio (HR) = 0.98, 95% CI = 0.97-0.99], and HCQ and SSZ use were risk factors (HR = 1.81, 95% CI = 1.24-2.64, and HR = 3.79, 95% CI = 1.69-8.42, respectively). Glucocorticoid use was a risk factor for a severe BI (HR = 3.61, 95% CI = 1.09-11.8). Non-white ethnicity (HR = 2.61, 95% CI = 1.03-6.59) was a risk factor for hospitalization. Compared with other groups, patients with IIMs required more supplemental oxygen therapy (IIMs = 6.0% vs AIRDs = 1.8%, nrAIDs = 2.2% and HCs = 0.9%), intensive care unit admission (IIMs = 2.2% vs AIRDs = 0.6%, nrAIDs and HCs = 0%), advanced treatment with antiviral or monoclonal antibodies (IIMs = 34.1% vs AIRDs = 25.8%, nrAIDs = 14.6% and HCs = 12.8%) and had more hospitalization (IIMs = 7.7% vs AIRDs = 4.6%, nrAIDs = 1.1% and HCs = 1.5%). CONCLUSION: Patients with IIMs are susceptible to severe COVID-19 BIs. Age and immunosuppressive treatments were related to the risk of BIs.MedicineArticleSCOPUS10.1093/rheumatology/keae1282-s2.0-852175180771462033238430474