Objectives The treatment for COVID-19 often utilizes immune-modulating drugs. These drugs are also used in immune mediated inflammatory diseases (IMIDs). We performed a systematic review about seroconversion after SARS-CoV-2 vaccination in patients with IMIDs and impact of various drugs on seroconversion rates. Methods Electronic databases were searched to identify relevant studies reporting seroconversion rates following SARS-CoV-2 vaccination in IMIDs. We calculated the pooled seroconversion rates after a single or two doses of vaccination, pooled seroconversion rates in patients with specific IMIDs, and rates in patients on various drugs/drug classes. Results Twenty-five studies were included in the systematic review. The pooled seroconversion rates after two doses of mRNA vaccination were higher (83.1, 95%CI: 74.9–89.0, I 2 = 90%) as compared to a single dose (69.3, 52.4–82.3, I 2 = 95%). The odds of seroconversion were lower in IMIDs as compared to healthy controls (0.05, 0.02–0.13, I 2 = 21%). The seroconversion rates in patients with inflammatory bowel disease (95.2, 95%CI: 92.6–96.9, I 2 = 0%), spondyloarthropathy (95.6, 95% CI: 83.4–98.9, I 2 = 35%), and systemic lupus erythematosus (90.7, 95%CI: 85.4–94.2, I 2 = 0%) were higher as compared to rheumatoid arthritis (79.5, 95% CI: 65.1–88.9, I 2 = 85%), and vasculitis (70.5, 95% CI: 52.9–83.5, I 2 = 51%). The seroconversion rates following double dose of mRNA were excellent (>90%) in those on anti-tumour necrosis factor (TNF), anti-integrin (vedolizumab), anti-IL 17 (secukinumab), anti-IL6 (Tocilizumab) and anti-IL12/23 (Ustekinumab) therapies but attenuated (<70%) in patients on anti-CD20 (Rituximab) or anti-cytotoxic T lymphocyte associated antigen (CTLA-4) therapies (Abatacept). The seroconversion rates were good (70–90%) with steroids, hydroxychloroquine, JAK inhibitors, mycophenolate mofetil and leflunomide. Combination of anti-TNF with immunomodulators (azathioprine, 6-meracptopurine, methotrexate) resulted in an attenuated vaccine response as compared to anti-TNF monotherapy. Conclusion Seroconversion rates after SARS-CoV-2 vaccination are lower in patients with IMIDs. Certain therapies (anti-TNF, anti-integrin, anti-IL 17, anti-IL6, anti-12/23) do not impact seroconversion rates while others (anti-CD20, anti-CTLA-4) result in poorer responses.

Background Liver function derangements have been reported in coronavirus disease (COVID-19), but reported rates are variable. Methods We searched PubMed and Embase with terms COVID and SARS-COV-2 from December 1, 2019 till April 5, 2020. We estimated overall prevalence, stratified prevalence based on severity, estimated risk ratio (RR), and estimated standardized mean difference (SMD) of liver function parameters in severe as compared to non-severe COVID. Random effect method utilizing inverse variance approach was used for pooling the data. Results In all, 128 studies were included. The most frequent abnormalities were hypoalbuminemia [61.27% (48.24-72.87)], elevations of gamma-glutamyl transferase (GGT) [27.94% (18.22-40.27)], alanine aminotransferase (ALT) [23.28% (19.92-27.01)], and aspartate aminotransferase (AST) [23.41% (18.84-28.70)]. Furthermore, the relative risk of these abnormalities was higher in the patients with severe COVID-19 when compared to non-severe disease [Hypoalbuminemia-2.65 (1.38-5.07); GGT-2.31 (1.6-3.33); ALT-1.76 (1.44-2.15); AST-2.30 (1.82-2.90)]. The SMD of hypoalbuminemia, GGT, ALT, and AST elevation in severe as compared to non-severe were − 1.05 (− 1.27 to − 0.83), 0.76 (0.40-1.12), 0.42 (0.27-0.56), and 0.69 (0.52-0.86), respectively. The pooled prevalence and RR of chronic liver disease as a comorbidity was 2.64% (1.73-4) and 1.69 (1.05-2.73) respectively. M. Praveen Kumar and Shubhra Mishra have contributed equally to this work.

Background: Liver function derangements have been reported in coronavirus disease (COVID-19) but reported rates are variable. Methods: We searched Pubmed and Embase with terms COVID and SARS-COV-2 from December 1, 2019 till April 5, 2020. We estimated overall prevalence, stratified prevalence based on severity, estimated risk ratio (RR) and estimated standardized mean difference (SMD) of liver function parameters in severe as compared to nonsevere COVID. Random effect method utilizing inverse variance approach was used for pooling the data. Results: In all, 128 studies were included. The most frequent abnormalities were hypoalbuminemia [61.27% (48.24 - 72.87)], elevations of gamma-glutamyl transferase (GGT) [27.94%(18.22 -40.27)], alanine aminotransferase (ALT) [23.28%(19.92 - 27.01)] and aspartate aminotransferase (AST) [23.41%(18.84 - 28.70)]. Further the relative risk of these abnormalities was higher in the patients with severe COVID-19 when compared to non-severe disease [Hypoalbuminemia - 2.65(1.38 - 5.07); GGT - 2.31(1.6 - 3.33); ALT - 1.76(1.44 - 2.15); AST 2.30(1.82 - 2.90)]. The SMD of hypoalbuminemia, GGT, ALT and AST elevation in severe as compared to nonsevere were -1.05(-1.27 - -0.83), 0.76(0.40 - 1.12), 0.42(0.27 - 0.56) and 0.69 (0.52 - 0.86) respectively. The pooled prevalence and RR of chronic liver disease as a comorbidity was 2.64% (1.73- 4) and 1.69(1.05-2.73) respectively. Conclusion: The most frequent abnormality in liver functions was hypoalbuminemia followed by derangements in gamma-glutamyl transferase and aminotransferases and these abnormalities were more frequent in severe disease. The systematic review was, however, limited by heterogeneity in definitions of severity and liver function derangements.

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