PREVALENCE, CHARACTERISTICS, AND PREDICTORS OF BREAKTHROUGH COVID-19 INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE COVID-19 VACCINATION IN AUTOIMMUNE DISEASE (COVAD) STUDYSaint Joseph University of Beirut, Rheumatology Department, Bayrut, Lebanon; Hôtel-Dieu de France, Rheumatology Department, Bayrut, Lebanon.
Pomeranian Medical University, Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Szczecin, Poland.
The University of Pavia, Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Pavia, Italy.
University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom; Trust Headquarters, Leeds Teaching Hospitals NHS Trust, NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom.
The University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, United Kingdom; Salford Royal, Manchester Centre for Clinical Neurosciences, Salford, United Kingdom.
Southport & Ormskirk Hospital NHS Trust, Southport, United Kingdom.
University of Bristol, Bristol Medical School Translational Health Sciences, Bristol, United Kingdom; North Bristol NHS Trust, Department of Rheumatology, Bristol, United Kingdom.
Rayne Building, UCL, Department of Rheumatology, Division of Medicine, London, United Kingdom; University College London, Centre for Adolescent Rheumatology Versus Arthritis, London, United Kingdom.
Faculty of Medicine Siriraj Hospital, Mahidol University, Division of Rheumatology, Department of Medicine, Bangkok, Thailand.
Queen Savang Vadhana Memorial Hospital, Department of Medicine, Tambon Si Racha, Thailand.
Karolinska Institute, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden; The Royal Wolverhampton NHS Trust, Department of Rheumatology, Wolverhampton, United Kingdom.
The University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom; Salford Royal, Department of Rheumatology, Salford, United Kingdom.
University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, United States of America.
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Clinical Immunology and Rheumatology, Lucknow, India.
King’s College London, Centre for Rheumatic Diseases, London, United Kingdom; King’s College Hospital, Rheumatology Department, London, United Kingdom.
Show others and affiliations
2023 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 82, no Suppl. 1, p. 56-56, article id OP0081Article in journal, Meeting abstract (Other academic) Published
Abstract [en]
Background: Global data on COVID-19 breakthrough infections (BI) following COVID-19 vaccination among autoimmune rheumatic diseases (AIRDs) and especially rheumatoid arthritis (RA) is scarce.
Objectives: This study aimed to examine the characteristics of COVID-19 BI among patients with RA and compare them with AIRDs and healthy controls (HCs).
Methods: A global e-survey, January-May 2022, collected data on COVID-19 vaccination, and BI in patients with RA, AIRDs, non-rheumatic autoimmune disease (nrAIDs), and HCs. BI was defined as infection after both primary or booster vaccine doses. Severe BI was defined as the need for hospitalization, including intensive unit care, oxygen therapy, or advanced treatment in the form of monoclonal antibodies.
Results: Of the 9595 vaccinated respondents of the e-survey, 3224 (33.6%) reported COVID-19. One BI was reported in 323/1802 (17.9%) patients with RA, 584/3869 (15.0%) patients with other AIRDs, and 467/3435 (13.5%) HCs. Similarly, second BI was reported by 280 (8.6%); 42 (2.3%) among RA, 90 (2.3%) among other AIRDs, and 124 (3.6%) among HCs.
The prevalence of first BI in patients with RA was higher than that in those with AIRDs (OR=1.2; 95%CI=1.1-1.4; p=0.001) and HCs (OR=1.4; 95%CI=1.2-1.6; p<0.001), but similar to nrAIDs (p=0.783). The prevalence of second BI was lower in patients with RA than in HCs (OR=0.6; 95%CI=0.4-0.9; p=0.012) and nrAIDs (OR=0.4; 95%CI=0.2-0.7; p=0.004), but similar to AIRDs (p=0.991). When compared with HCs, patients with RA reported significantly higher joint pain, hospitalizations, and need for advanced treatment at first BI. Patients with RA from very high HDI countries had lower hazard of first BI than those from high HDI countries (HR=0.026; 95%CI=0.001-0.6; p=0.027). Rituximab use predicted more frequent hospitalization (OR=3.4; 95%CI=1.3-11.4; p=0.045) and severe BI (OR=3.0; 95%CI=1.2-7.3; p=0.014).
Conclusion: Nearly one in five patients with RA reported BI. BI prevalence was higher in patients with RA and of higher severity than in HCs. Country HDI was an important determinant of outcomes, suggesting potential impact of environmental dynamics, local vaccination policy, and syndemic constructs that merit further exploration. Rituximab use predicted more frequent hospitalizations and more severe BI.
Place, publisher, year, edition, pages
HighWire Press , 2023. Vol. 82, no Suppl. 1, p. 56-56, article id OP0081
Keywords [en]
Rheumatoid arthritis, COVID, Vaccination/Immunization
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:oru:diva-111581DOI: 10.1136/annrheumdis-2023-eular.2156ISI: 001107398700082OAI: oai:DiVA.org:oru-111581DiVA, id: diva2:1838383
Conference
European Congress of Rheumatology, (EULAR 2023), Milan, Italy, May 31 - June 3, 2023
2024-02-162024-02-162024-02-16Bibliographically approved