Clinical characteristics and outcomes of COVID-19 breakthrough infections among vaccinated patients with systemic autoimmune rheumatic diseases

Abstract

Objective To describe the characteristics of COVID-19 vaccine breakthrough infections among systemic autoimmune rheumatic disease (SARD) patients. Methods We identified SARDs patients in a large healthcare system with COVID-19 vaccination at least 14 days prior to a positive SARS-CoV-2 molecular test. Details of the SARD diagnosis, vaccination status, and COVID-19 infection were extracted. Results Of 340 confirmed COVID-19 infections among SARDs patients between December 11th, 2020 (date of first COVID-19 vaccine approval in the US) and July 30th, 2021, we identified 16 breakthrough infections. Seven (44%) received the Pfizer-BioNtech vaccine, five (31%) received the Moderna vaccine, and four (25%) received the Janssen/Johnson & Johnson vaccine. The most common SARDs included rheumatoid arthritis (6, 38%), inflammatory myopathy (3, 19%), and systemic lupus erythematosus (3, 19%). Rituximab (5, 31%), glucocorticoids (4, 25%), and mycophenolate mofetil (4, 25%) were the most frequent treatments. Among the breakthrough infections, 15 (93%) were symptomatic, six (38%) were hospitalized, one (6%) required mechanical ventilation, and two (13%) died. Conclusions Symptomatic, including severe, breakthrough infections were observed in SARDs patients; many were on treatments associated with attenuated antibody responses to vaccination. Further studies are needed to determine the rate of breakthrough infection associated with SARD treatments and other features.

COVID-19 Breakthrough Infection Among Immunocompromised Persons

“…4 A recent report from the Mass General Brigham health care system identified COVID-19 infection in 340 patients with systemic autoimmune rheumatic diseases who were diagnosed after the availability of SARS-CoV-2 vaccines. 6 Breakthrough infection in fully vaccinated patients accounted for 16 infections (4.7%). Of these breakthrough infection cases, 15 (93%) were symptomatic, 6 (38%) were hospitalized, 1 (6%) required mechanical ventilation, and 2 (13%) died.…”

“…Of these breakthrough infection cases, 15 (93%) were symptomatic, 6 (38%) were hospitalized, 1 (6%) required mechanical ventilation, and 2 (13%) died. 6 In a recent study of hospitalized patients with a breakthrough infection, 44% were found to be vaccinated immunocompromised patients. 7 Findings from these studies suggest that blunted immune responses after SARS-CoV-2 vaccination in some patients with immune dysfunction may be associated with an increased risk for a breakthrough COVID-19 infection that can have severe and even fatal outcomes.…”

“…SARS-CoV-2 vaccine clinical trials did not initially include individuals with immune dysfunction conditions, which has led to some hesitancy in using the available vaccines in this population. However, several recent retrospective studies have reported reassuring data regarding the safety of these vaccines in immunocompromised patients, [2][3][4][5][6] and the general consensus is that the potential benefits of vaccination substantially outweigh the risks. 9 The Centers for Disease Control and Prevention, along with a number of professional societies, endorse SARS-CoV-2 vaccination for the immunocompromised population.…”

Breakthrough SARS-CoV-2 infections in immune mediated disease patients undergoing B cell depleting therapy

“…While patients with IMIDs on BCDTs have been recognized to be vulnerable to severe COVID-19 infections, 3,4,6,7 relatively scant data exist regarding their risks for and outcomes of breakthrough infections 2,18 . The current cohort of breakthrough patients consisted of nearly equal numbers of patients with rheumatic and neuro-inflammatory disease and most (91.9%) were either fully vaccinated or boosted, with only 6 (8.1%) with incomplete vaccination.…”

“…The deployment of vaccines to both prevent infection with SARS-CoV-2 as well as limit the severity of COVID-19 has proven efficacious for the general population. However, data on patients with underlying immunocompromising conditions, including those with immune mediated inflammatory diseases (IMIDs), suggest they have both an increased likelihood for developing breakthrough infections as well as for experiencing more severe outcomes despite full vaccination status 1,2 .…”