Immunogenicity, breakthrough infection, and underlying disease flare after SARS-CoV-2 vaccination among individuals with systemic autoimmune rheumatic diseases

Paik, Julie J; Sparks, Jeffrey A.; Kim, Alfred H.J.

doi:10.1016/j.coph.2022.102243

Cited by 17 publications

(19 citation statements)

References 59 publications

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“…However, no other study to date has examined the temporal trends in COVID-19 outcomes among SARDs extending up to the initial Omicron wave. These findings are particularly relevant given the blunted vaccine response and associated higher risk of breakthrough infections that have been observed in some patients with SARDs 24…”

Section: Discussionmentioning

confidence: 98%

“…These findings are particularly relevant given the blunted vaccine response and associated higher risk of breakthrough infections that have been observed in some patients with SARDs. 24 The introduction of effective vaccines represented a key turning point in the pandemic and despite waning efficacy with time and against novel variants, they continue to provide important protection against severe disease. 25 In our study of patients with SARDs, the majority of whom were on immunosuppressive treatments previously associated with blunted vaccine responses, we found that vaccination was associated with less severe COVID-19.…”

Section: Discussionmentioning

confidence: 99%

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Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: from the first wave through the initial Omicron wave

et al. 2022

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ObjectivesTo investigate temporal trends in incidence and severity of COVID-19 among patients with systemic autoimmune rheumatic diseases (SARDs) from the first wave through the initial Omicron wave.MethodsWe conducted a retrospective cohort study investigating COVID-19 outcomes among patientswith SARD systematically identified to have confirmed COVID-19 from 1 March 2020 to 31 January 2022 at Mass General Brigham. We tabulated COVID-19 counts of total and severe cases (hospitalisations or deaths) and compared the proportion with severe COVID-19 by calendar period and by vaccination status. We used logistic regression to estimate the ORs for severe COVID-19 for each period compared with the early COVID-19 period (reference group).ResultsWe identified 1449 patients with SARD with COVID-19 (mean age 58.4 years, 75.2% female, 33.9% rheumatoid arthritis). There were 399 (28%) cases of severe COVID-19. The proportion of severe COVID-19 outcomes declined over calendar time (p for trend <0.001); 46% of cases were severe in the early COVID-19 period (1 March 2020–30 June 2020) vs 15% in the initial Omicron wave (17 December 2021–31 January 2022; adjusted OR 0.29, 95% CI 0.19 to 0.43). A higher proportion of those unvaccinated were severe compared with not severe cases (78% vs 60%).ConclusionsThe proportion of patients with SARD with severe COVID-19 has diminished since early in the pandemic, particularly during the most recent time periods, including the initial Omicron wave. Advances in prevention, diagnosis and treatment of COVID-19 may have improved outcomes among patients with SARD.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: from the first wave through the initial Omicron wave

et al. 2022

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“…However, no other study to date has examined the temporal trends in COVID-19 outcomes among SARDs extending up to the most recent Omicron wave. These findings are particularly relevant given the blunted vaccine response and associated higher risk of breakthrough infections that have been observed in some patients with SARDs 24 .…”

Section: Discussionmentioning

confidence: 95%

Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: From the first wave to Omicron

Kawano

Patel

Wang

et al. 2022

Preprint

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Objectives: To investigate temporal trends in incidence and severity of COVID-19 among patients with systemic autoimmune rheumatic diseases (SARDs) from the first wave through the Omicron wave. Methods: We conducted a retrospective cohort study investigating COVID-19 outcomes among SARD patients systematically identified to have confirmed COVID-19 from March 1, 2020 to January 31, 2022 at a large healthcare system in Massachusetts. We tabulated COVID-19 counts of total and severe cases (hospitalizations or deaths) and compared the proportion with severe COVID-19 by calendar period and by vaccination status. We used logistic regression to estimate the ORs for severe COVID-19 for each period compared to the early COVID-19 period (reference group). Results: We identified 1449 SARD patients with COVID-19 (mean age 58.4 years, 75.2% female, 33.9% rheumatoid arthritis). There were 399 (27.5%) cases of severe COVID-19. The proportion of severe COVID-19 outcomes declined over calendar time (p for trend <0.001); 45.6% of cases were severe in the early COVID-19 period (March 1-June 30, 2020) vs. 14.7% in the Omicron wave (December 17, 2021-January 31, 2022; adjusted odds ratio 0.29, 95%CI 0.19-0.43). A higher proportion of those unvaccinated were severe compared to not severe cases (78.4% vs. 59.5%). Conclusions: The proportion of SARD patients with severe COVID-19 has diminished since early in the pandemic, particularly during the most recent time periods, including the Omicron wave. Advances in prevention, diagnosis, and treatment of COVID-19 may have improved outcomes among SARD patients.

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“…Additionally, 1236 (11%) patients had a diagnosis of any malignancy excluding non-melanoma skin cancers. The median (IQR) Charlson Comorbidity Index was 1 (1,3).…”

Section: Study Samplementioning

confidence: 99%

“…SARS-CoV-2 vaccines are highly effective against severe outcomes even among immunosuppressed patients, but breakthrough infections after vaccination have been observed. [1][2][3][4] There is particular concern among patients with systemic autoimmune rheumatic diseases (SARDs) that some may be at increased risk of breakthrough infection because of underlying immune dysregulation, immunomodulatory or immunosuppressive medications, and comorbid conditions, which may contribute to decreased vaccine efficacy and predisposition to breakthrough infection. [5][6][7][8][9] Indeed, a number of medications commonly used to treat immunemediated diseases, including anti-CD20 monoclonal antibodies, antimetabolites (e.g., methotrexate, mycophenolate), glucocorticoids, and cytokine inhibitors (e.g., TNF inhibitors), have been associated with impaired humoral response to SARS-CoV-2 and other vaccines.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with COVID-19 Breakthrough Infection in the Pre-Omicron Era Among Vaccinated Patients with Rheumatic Diseases: A Cohort Study

Patel

Wang

et al. 2022

Preprint

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Objective: Rheumatic disease patients on certain immunomodulators are at increased risk of impaired humoral response to SARS-CoV-2 vaccines. We aimed to identify factors associated with breakthrough infection among patients with rheumatic diseases. Methods: We identified patients with rheumatic diseases being treated with immunomodulators in a large healthcare system who received at least two doses of either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) vaccines or one dose of the Johnson & Johnson-Janssen (J&J) vaccine. We followed patients until SARS-CoV-2 infection, death, or December 15, 2021, when the Omicron variant became dominant in our region. We estimated the association of baseline characteristics with the risk of breakthrough infection using multivariable Cox regression. Results: We analyzed 11,468 patients (75% female, mean age 60 years). Compared to antimalarial monotherapy, multiple immunomodulators were associated with higher risk of infection: anti-CD20 monoclonal antibodies (aHR 5.20, 95% CI: 2.85, 9.48), CTLA-4 Ig (aHR 3.52, 95% CI: 1.90, 6.51), mycophenolate (aHR 2.31, 95% CI: 1.25, 4.27), IL-6 inhibitors (aHR 2.15, 95% CI: 1.09, 4.24), JAK inhibitors (aHR 2.02, 95% CI: 1.01, 4.06), and TNF inhibitors (aHR 1.70, 95% CI: 1.09, 2.66). mRNA-1273 recipients had a lower risk of breakthrough infection compared to BNT162b2 recipients (aHR 0.66, 95% CI: 0.50, 0.86). There was no association of sex, body mass index, smoking status, race, or ethnicity with risk of breakthrough infection. Conclusion: Among patients with rheumatic diseases, multiple immunomodulators were associated with increased risk of breakthrough infection. These results highlight the need for additional mitigation strategies in this vulnerable population.

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Immunogenicity, breakthrough infection, and underlying disease flare after SARS-CoV-2 vaccination among individuals with systemic autoimmune rheumatic diseases

Cited by 17 publications

References 59 publications

Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: from the first wave through the initial Omicron wave

Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: from the first wave through the initial Omicron wave

Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: From the first wave to Omicron

Factors Associated with COVID-19 Breakthrough Infection in the Pre-Omicron Era Among Vaccinated Patients with Rheumatic Diseases: A Cohort Study

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