Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period—a cross-sequential study based on COVAD surveys

Media type: E-Article
Title: Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period—a cross-sequential study based on COVAD surveys
Contributor: Jagtap, Kshitij; Naveen, R; Day, Jessica; Sen, Parikshit; Vaidya, Binit; Nune, Arvind; Nikiphorou, Elena; Tan, Ai Lyn; Agarwal, Vishwesh; Saha, Sreoshy; Shinjo, Samuel Katsuyuki; Ziade, Nelly; Joshi, Mrudula; Velikova, Tsvetelina; Milchert, Marcin; Parodis, Ioannis; Edgar Gracia-Ramos, Abraham; Cavagna, Lorenzo; Kuwana, Masataka; Knitza, Johannes; Makol, Ashima; Patel, Aarat; Pauling, John D; Wincup, Chris; [...]
imprint: Oxford University Press (OUP), 2023
Published in: Rheumatology
Language: English
DOI: 10.1093/rheumatology/kead144
ISSN: 1462-0324; 1462-0332
Origination:
Footnote:
Description: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>Flares of autoimmune rheumatic diseases (AIRDs) following COVID-19 vaccination are a particular concern in vaccine-hesitant individuals. Therefore, we investigated the incidence, predictors and patterns of flares following vaccination in individuals living with AIRDs, using global COVID-19 Vaccination in Autoimmune Diseases (COVAD) surveys.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The COVAD surveys were used to extract data on flare demographics, comorbidities, COVID-19 history, and vaccination details for patients with AIRDs. Flares following vaccination were identified as patient-reported (a), increased immunosuppression (b), clinical exacerbations (c) and worsening of PROMIS scores (d). We studied flare characteristics and used regression models to differentiate flares among various AIRDs.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of 15 165 total responses, the incidence of flares in 3453 patients with AIRDs was 11.3%, 14.8%, 9.5% and 26.7% by definitions a–d, respectively. There was moderate agreement between patient-reported and immunosuppression-defined flares (K = 0.403, P = 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (P = 0.013), mental health disorders (MHDs) (P &lt; 0.001) and autoimmune disease multimorbidity (AIDm) (P &lt; 0.001).</jats:p> <jats:p>In regression analysis, the presence of AIDm [odds ratio (OR) = 1.4; 95% CI: 1.1, 1.7; P = 0.003), or a MHD (OR = 1.7; 95% CI: 1.1, 2.6; P = 0.007), or being a Moderna vaccine recipient (OR = 1.5; 95% CI: 1.09, 2.2; P = 0.014) were predictors of flares. Use of MMF (OR = 0.5; 95% CI: 0.3, 0.8; P = 0.009) and glucocorticoids (OR = 0.6; 95% CI: 0.5, 0.8; P = 0.003) were protective.</jats:p> <jats:p>A higher frequency of patients with AIRDs reported overall active disease post-vaccination compared with before vaccination (OR = 1.3; 95% CI: 1.1, 1.5; P &lt; 0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Flares occur in nearly 1 in 10 individuals with AIRDs after COVID vaccination; people with comorbidities (especially AIDm), MHDs and those receiving the Moderna vaccine are particularly vulnerable. Future avenues include exploring flare profiles and optimizing vaccine strategies for this group.</jats:p> </jats:sec>

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