Background/Purpose: Patients with dermatomyositis (DM) and antibodies (ab) to melanoma differentiation associated gene 5 (MDA5) share similar clinical characteristics to patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) including high risk of fatal, rapidly progressive interstitial lung disease (RP-ILD). Nearly 50% of patients with COVID 19 have anti-MDA5 ab, which are associated with worse outcomes (Front Immunol 2021 Dec 20;12:791348). Shared pathogenic pathways between MDA5 ab positive DM and COVID 19 have been proposed. The current work evaluated the clinical outcomes of anti-MDA5 positive DM patients following infection or vaccination for SARS-CoV-2.

Methods: A retrospective chart review of a large longitudinal idiopathic inflammatory myopathies (IIM) patient cohort at a single academic center was done to identify DM patients with anti-MDA5 ab. Chart review for a comparison cohort of DM patients with antibodies to TIF1 gamma was performed. Clinical variables collected from chart review included demographic information, SARS-CoV-2 vaccination status, type of vaccine used, dates of vaccinations, vaccine reactions, SARS-CoV-2 infection status, and medication use including changes in immunosuppressive agents at time of SARS-CoV-2 infection or vaccination.

Results: A total of 25 anti-MDA5 ab+ DM patients with ongoing follow-up appointments during the Covid pandemic were identified in the cohort, including 24 patients with data on SARS-CoV-2 infection and vaccination available for review (Age = 51 ± 15,70%F). 20 DM patients with TIF1 gamma ab were identified with active follow-up including 17 patients with SARS-CoV-2 data for review (Age= 46 ± 15, 94%F). 23/25 MDA5 ab positive patients and 17/17 TIF1 gamma ab positive patients received vaccination for SARS-CoV-2. Adverse reactions associated with vaccination were generally minor and of short duration. One patient in the TIF1 gamma ab group had a DM disease flare with vaccination requiring increase in steroid dose. The most common adverse events with vaccination across both DM groups included injection site soreness (44%) followed by fatigue/malaise (24%), upper respiratory symptoms (5%), headache (5%,) fever (5%), and rash (2%). Symptoms generally lasted 1-3 days and resolved without intervention. No differences in these adverse events were noted between MDA5 and TIF1 gamma ab positive groups (p >0.05 for Chi Square/Fisher’s exact test). 8 MDA5 ab positive patients including one patient without vaccination had Covid 19. None of these patients were hospitalized or had disease flares associated with Covid 19 and all had mild symptoms with full recovery. No documented Covid 19 occurred in the TIF1 gamma ab group.

Conclusion: Vaccination againstSARS-CoV-2 was generally well tolerated in a cohort of patients with anti-MDA5 antibody positive DM. Adverse reactions to vaccination were similar to those reported in the general population (JAMANetw Open.2021;4(12)) and a comparison anti-TIF1 gamma antibody positive DM cohort. No hospitalizations for Covid 19 or disease flares occurred in 8 MDA5 ab positive patients infected with SARS-CoV-2.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-outcomes-following-severe-acute-respiratory-syndrome-coronavirus-2-sars-cov-2-infection-and-vaccination-in-patients-with-anti-melanoma-differentiation-associated-gene-5-mda5-antibody-posi/