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Vaccinated rheumatic patients carry increased risk for COVID-19 breakthrough infections

Presented by
Prof. Jasvinder Singh, University of Alabama at Birmingham, AL, USA
ACR 2021
Compared with the general population, breakthrough infections after COVID-19 vaccination happen more often in patients who suffer from autoimmune or inflammatory rheumatic diseases. The risk of infection is affected by the type of medication and pre-existing diagnosis.

“COVID-19 vaccines are highly effective in the general population, but we also know that in certain populations, such as elderly and severely immunocompromised, they may have reduced effectiveness,” Prof. Jasvinder Singh (University of Alabama at Birmingham, AL, USA) explained [1]. For certain drug classes, like glucocorticoids and B-cell depleting agents, a reduction in antibody response has already been found, but much is unknown about other treatments and rheumatic diseases [2]. Therefore, the current study aimed to investigate the possibility of an increased risk for breakthrough infection after COVID-19 vaccination in patients with autoimmune or inflammatory rheumatic diseases [1]. Data from the National COVID Cohort Collaborative served as the source for the investigation, providing a sample of 577,335 vaccinated people, of whom 47,303 had a rheumatic disease. An incident COVID-19 diagnosis that occurred at least 14 days after vaccination was defined as a breakthrough infection.

Overall, the median age within the cohort was 48 years, 58% were women, 58% White, 18% Hispanic, and 11% Black. Over 90% were fully vaccinated, most of them (around 70%) with the Pfizer-BioNTech vaccine. The rate of breakthrough infections in people without rheumatic disease was 3%. The prevalence in those with rheumatic disease ranged from 3.3% in lupus to 4.5% in rheumatoid arthritis, and 4.7% in polymyalgia rheumatica. In the subgroup that received Pfizer-BioNTech, this translated into a crude prevalence rate of 31.2/1,000 persons in the patients without rheumatic disease versus 41.5/1,000 patients with rheumatic disease. Taking subjects without rheumatic disease as a reference, significantly higher adjusted odds ratios for breakthrough infection were found for rheumatoid arthritis (OR 1.33; P<0.001), gout (OR 1.14; P=0.001), polymyositis (OR 1.97; P=0.018), polymyalgia rheumatica (OR 1.2; P=0.14), vasculitis (OR 1.19; P=0.004), and multiple rheumatic diseases (OR 1.17; P=0.011). Moreover, the researchers differentiated between various treatment drugs in comparison with no immunosuppressive medication. Significance was found for exposure to biologics, which was associated with an adjusted OR of 1.61 (P=0.002) and multiple autoimmune/rheumatic disease medications with a 38% higher likelihood of breakthrough infections (OR 1.38; P<0.001).

“This data, we believe, has important information and guide for patients, providers, and policymakers, and although more research is needed to examine several important questions that our study generates, we still support the use of at least a third dose of COVID-19 vaccine for immunocompromised patients, including those with rheumatic or autoimmune diseases, or those getting medications that are associated with immunosuppression and continued use of other precautions,” concluded Prof. Singh.

  1. Deepak P, et al. Ann Intern Med. 2021 Nov;174(11):1572-1585.

  2. Singh J. Breakthrough COVID-19 infections post-vaccination among immunocompromised patients with autoimmune or inflammatory rheumatic diseases: a retrospective cohort analysis from a U.S. Nationally-sampled Electronic Medical Record Data Repository. Abstract L16, ACR Convergence 2021, 03–10 November.


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