Effects of anti‐SARS‐CoV‐2 vaccination on safety and disease exacerbation in patients with Behçet syndrome in a monocentric cohort

Abstract

Aim Vaccination represents a cornerstone in mastering the coronavirus disease 2019 (COVID‐19) pandemic. There is a paucity of data regarding the safety of COVID‐19 vaccines in patients with rheumatic diseases such as Behçet syndrome (BS). The present study aimed to investigate the side‐effects and post‐vaccine disease exacerbation rates of COVID‐19 vaccines in a BS cohort. Methods We retrospectively evaluated 450 BS patients followed in our clinic who met the criteria of the International Study Group. COVID‐19 vaccination status, type of vaccine received (Pfizer‐BioNTech vs CoronaVac), post‐vaccine side‐effects and exacerbations were evaluated by interviewing patients over the phone or face to face. Behçet's Disease Current Activity Form (BDCAF) scores were calculated for BS symptoms before and after vaccination. Results In all, 287 patients received at least one dose of the COVID‐19 vaccine. Of the total number of COVID‐19 vaccines (n = 639), 379 (59%) were Pfizer‐BioNTech vaccines and 257 (41%) were CoronaVac vaccines. The number of side‐effects after first, second, third and fourth vaccine doses were 151 (52.6%), 135 (49.4%), 29 (42.6%), and 3 (30%), respectively. BS exacerbation after first, second, third, and fourth vaccine doses were 151 (52.6%), 135 (49.4%), 16 (23.5%), and 3 (30%), respectively. Injection site pain/swelling was the most common side‐effect at all vaccine doses followed by fatigue and arthralgia. Conclusion COVID‐19 vaccines are well tolerated in patients with BS, and more side‐effects develop after mRNA vaccines. Regardless of the vaccine type, exacerbations after the COVID‐19 vaccine are common, predominantly mucocutaneous and articular involvement, and exacerbations in the form of other organ involvement are rare.

Anti‐SARS‐CoV‐2 vaccination, safety and disease exacerbation in Behçet's syndrome: Correspondence

“…According to Apaydin et al, COVID‐19 vaccines are well tolerated by Behçet's syndrome patients, whereas more side effects appear following messenger RNA vaccines. Regardless of the vaccine type, exacerbations following the COVID‐19 vaccine are frequent, primarily involving the mucosa and joints, while exacerbations involving other organs are uncommon 1 . We both agree there may be a connection between the COVID‐19 infection and the vaccine.…”

“…we would like to share ideas on “Effects of anti‐SARS‐CoV‐2 vaccination on safety and disease exacerbation in patients with Behçet syndrome in a monocentric cohort” 1 . According to Apaydin et al, COVID‐19 vaccines are well tolerated by Behçet's syndrome patients, whereas more side effects appear following messenger RNA vaccines.…”

Case report: Deep vein thrombosis as the sole clinical feature of Behcet’s syndrome

“…However, prevailing theories suggest a potential mechanism involving non-specific lymphocytic cell hypersensitivity or molecular mimicry ( 7 ). Alternatively, the potential of the SARS-CoV-2 booster shot to act as a trigger should not be overlooked, particularly in light of reported symptoms exacerbation in BD patients following vaccination ( 8 ).…”

COVID‐19 vaccination and autoimmunity: Causality, precipitation or chance association?

“…Disease with a predominant autoinflammatory phenotype (more of innate immunityactivation)suchasBeçhet'sdiseaseorfamilialMediterraneanfeverhavereportedmorepost-vaccineflares. 10,11 Thus, the jury is still out on whether COVID-19 vaccines precipitate autoimmunity or not. The safety of COVID vaccination in both children and adults with autoimmunity has been proven beyond doubt.…”

“…The effect of disease needs to be understood as well. Disease with a predominant autoinflammatory phenotype (more of innate immunity activation) such as Beçhet's disease or familial Mediterranean fever have reported more post‐vaccine flares 10,11 …”