NYU Langone Presentations At American College of Rheumatology Convergence 2021 To Address Vaccine Efficacy & High-Risk Pregnancy

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NYU Langone rheumatologists are presenting their discoveries at the annual American College of Rheumatology conference, November 1 to November 9. The conference will be held virtually.

Topics presented will include COVID-19 vaccine efficacy in lupus patients, 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 said Jill P. Buyon, MD, the Sir Deryck and Lady Va Maughan Professor of Rheumatology, and director of the Division of Rheumatology at NYU Grossman School of Medicine. "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 is made up of more than 100 physicians and scientists, treating patients 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 will receive distinctions from the college. Some research being highlighted by ACR includes the following.

Abstract Session 1420: Evaluation of SARS-CoV-2 Vaccine Response in a Multi-Racial/Ethnic Cohort of Patients with Systemic Lupus Erythematosus

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 vaccinations. In this multi-ethnic/racial study of systemic lupus erythematosus (SLE) patients, 29 percent produced lower than normal IgG antibodies against SARS-CoV-2 spike receptor-binding domain.

Peter Izmirly, MD, associate professor of medicine at NYU Langone Health, led a team in observing 90 SLE patients 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 has 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."

Abstract Session 1464: Ambulatory Fetal Heart Rate Monitoring (FHRM) to Surveil Pregnancies at Risk for Congenital Heart Block

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 of women with these antibodies, and is a serious risk of fetal illness or death.

37 mothers with anti-Ro/SSA antibodies were trained to perform FHRM to monitor for heart rhythm abnormalities. From weeks 17-25 of gestation, study participants completed FHRM three 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 it was normal or referred them for an emergency fetal echocardiogram if abnormal.

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 Jill P. Buyon, MD, the Sir Deryck and Lady Va Maughan Professor of Rheumatology, and director of the Division of Rheumatology at NYU Grossman School of Medicine. "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."

Abstract Session 1743: Whole Blood Hydroxychloroquine Levels Do Not Correlate with QTc Intervals in a Cohort of 84 SLE Patients: Evidence That Antimalarials Are Not Associated with Cardiac Conduction System Toxicity

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 SLE patients 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/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, 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 of medicine at NYU Langone Health 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."

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