Pleuropulmonary and Bronchial Infections

Multidose BCG Vaccine Protects Against COVID-19 in At-Risk Individuals

It is unclear whether disease control prevents RA-related bone loss, but data suggest it does in patients with early RA and high disease activity.1 Two systemic analyses of RA studies concluded that biologic DMARDs reduce generalized and localized bone loss.2,19 However, few studies were phase 3 trials, and most measured markers of bone turnover.2,19 High-quality trials that measure BMD change or fracture risk are needed. Bisphosphonates, denosumab, and parathyroid hormone are agents approved for osteoporosis and glucocorticoid-induced osteoporosis. Bisphosphonates and denosumab appear to have similar efficacy at preserving BMD.1 In some RA studies, denosumab also prevented and repaired erosions.2 The ACR guidelines for glucocorticoid-induced osteoporosis categorize patients as having low, moderate, or high fracture risk.18 They recommend calcium (1000 to 1200 mg/d) and vitamin D (600 to 800 IU/d) supplements for all patients, plus an osteoporosis agent (preferably an oral bisphosphonate) for patients with moderate to high fracture risk.

It is unclear whether disease control prevents RA-related bone loss, but data suggest it does in patients with early RA and high disease activity.1 Two systemic analyses of RA studies concluded that biologic DMARDs reduce generalized and localized bone loss.2,19 However, few studies were phase 3 trials, and most measured markers of bone turnover.2,19 High-quality trials that measure BMD change or fracture risk are needed. Bisphosphonates, denosumab, and parathyroid hormone are agents approved for osteoporosis and glucocorticoid-induced osteoporosis. Bisphosphonates and denosumab appear to have similar efficacy at preserving BMD.1 In some RA studies, denosumab also prevented and repaired erosions.2

The ACR guidelines for glucocorticoid-induced osteoporosis categorize patients as having low, moderate, or high fracture risk.18 They recommend calcium (1000 to 1200 mg/d) and vitamin D (600 to 800 IU/d) supplements for all patients, plus an osteoporosis agent (preferably an oral bisphosphonate) for patients with moderate to high fracture risk.

The multidose BCG vaccine offers protection against COVID-19 infection among COVID-19-unvaccinated individuals with type 1 diabetes.

HealthDay News — The multidose Bacillus Calmette-Guerin (BCG) vaccine offers protection against COVID-19 infection among COVID-19-unvaccinated individuals with type 1 diabetes, according to a study published online Aug. 15 in Cell Reports Medicine.

Denise L. Faustman, M.D., Ph.D., from Massachusetts General Hospital in Boston, and colleagues evaluated the safety and efficacy of the multidose BCG vaccine for preventing COVID-19 and other infectious diseases among an at-risk cohort of COVID-19-unvaccinated individuals with type 1 diabetes. A total of 144 individuals were enrolled: 96 and 48 were randomly assigned to BCG and placebo, respectively. During the 15-month trial, there were no drop-outs.

The researchers found that the cumulative incidence of meeting the criteria for COVID-19 was 12.5 and 1.0 percent among placebo-treated and BCG vaccine-treated participants, respectively, resulting in an efficacy of 92 percent. Fewer infectious disease symptoms and less severity were seen in the BCG group, and there were fewer infectious disease events per patient, including COVID-19. No BCG vaccine-related systemic adverse events were reported.

“The BCG vaccine effectively protects against COVID-19 and provides broad infectious disease protection as now tested with a formal double-blinded and randomized clinical trial,” the authors write. “Also the BCG vaccine is safe, effective, affordable, and potentially protective against ever-changing viral variants of the COVID-19 pandemic, based on its broad-based protection against other infections.”

Abstract/Full Text (subscription or payment may be required)

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