Several autoimmune or inflammatory rheumatic diseases are associated with an increased risk for experiencing a breakthrough COVID-19 infection, despite complete vaccination. The risk varies according to the type of diagnosis and class of treatment drug. The current study aimed to investigate a possible increased risk for breakthrough infection after COVID-19 vaccination in patients with rheumatic diseases.1 Data from the National COVID Cohort Collaborative served as the source for the investigation, providing a sample of 577,335 vaccinated people, of whom 514,888 did not suffer from rheumatic diseases. An incident COVID-19 diagnosis that occurred at least 14 days after vaccination was defined as a breakthrough infection. Overall, the median age within the cohort was 48, 58% were women, 58% White, 18% Hispanic, and 11% Black. More than 90% were fully vaccinated, most (around 70%) with the Pfizer-BioNTech vaccine. The rate of breakthrough infections in people without rheumatic diseases was 3%. The prevalence ranged from 3.3% in lupus to 4.5% in rheumatoid arthritis, and 4.7% in polymyalgia rheumatica. In the subgroup that received Pfizer-BioNTech, this translated into a crude prevalence rate of 31.2/1,000 persons in the non-immunocompromised versus 41.5/1,000 patients with rheumatic diseases. Also, the cumulative incidence was higher in patients with rheumatic and autoimmune disease, with the highest values seen for poly/dermatomyositis. Taking subjects without rheumatic disease as a reference, significantly higher adjusted odds ratios for breakthrough infection were found for rheumatoid arthritis (OR, 1.33; P<0.001), gout (OR, 1.14; P=0.001), polymyositis (OR, 1.97; P=0.018), polymyalgia rheumatica (OR, 1.2; P=0.14), vasculitis (OR, 1.19; P=0.004) and multiple rheumatic diseases (OR, 1.17; P=0.011). Moreover, the researchers differentiated between various treatment drugs in comparison with no immunosuppressive medication. Significance was found for exposure to biologics, which was associated with an adjusted OR of 1.61 (P=0.002) and multiple rheumatic disease medications with a 38% higher likelihood of breakthrough infections (OR, 1.38; P<0.001). “This data, we believe, has important information and guide for patients, providers, and policymakers, and although more research is needed to examine several important questions that our study generates, we still support the use of at least a third dose of COVID-19 vaccine for immunocompromised patients, including those with rheumatic or autoimmune diseases, or those getting medications that are associated with immunosuppression and continued use of other precautions,” concluded Jasvinder Singh, MD, MPH (University of Alabama at Birmingham).

  1. Singh J. Breakthrough COVID-19 infections post-vaccination among immunocompromised patients with autoimmune or inflammatory rheumatic diseases: a retrospective cohort analysis from a U.S. Nationally-sampled Electronic Medical Record Data Repository. L16, ACR Convergence 2021, 3-10. November.

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