Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period—a cross-sequential study based on COVAD surveys
Kshitij Jagtap, R Naveen, Jessica Day, Parikshit Sen, Binit Vaidya, Arvind Nune, Elena Nikiphorou, Ai Lyn Tan, Vishwesh Agarwal, Sreoshy Saha, Samuel Katsuyuki Shinjo, Nelly Ziadé, Mrudula Joshi, Tsvetelina Velikova, Marcin Milchert, Ioannis Parodis, Abraham Edgar Gracia‐Ramos, Lorenzo Cavagna, Masataka Kuwana, Johannes Knitza, Ashima Makol, Aarat Patel, John D Pauling, Chris Wincup, Bhupen Barman, Erick Adrian Zamora Tehozol, Jorge Rojas‐Serrano, Ignacio García‐De La Torre, I. J. Colunga-Pedraza, Javier Merayo‐Chalico, Okwara Celestine Chibuzo, Wanruchada Katchamart, Phonpen Akawatcharangura Goo, Russka Shumnalieva, Yi‐Ming Chen, Leonardo Santos Hoff, Lina El Kibbi, Hussein Halabi, Syahrul Sazliyana Shaharir, A T M Tanveer Hasan, Dzifa Dey, Carlos Enrique Toro Gutiérrez, Carlo V. Caballero‐Uribe, James B Lilleker, Babur Salim, Tamer A. Gheita, Tulika Chatterjee, Miguel Ángel Saavedra, Oliver Distler, COVAD Study Group, Zoltán Griger, Sinan Kardeş, Laura Andréoli, Daniele Lini, Karen Schreiber, Melinda Nagy Vince, Yogesh Preet Singh, Rajiv Ranjan, Avinash Jain, Sapan C Pandya, Rakesh Kumar Pilania, Aman Sharma, Manesh Manoj, Vikas Gupta, Chengappa Kavadichanda, Pradeepta Sekhar Patro, Sajal Ajmani, Sanat Phatak, Rudra Prosad Goswami, Abhra Chandra Chowdhury, Ashish Jacob Mathew, Padnamabha Shenoy, Ajay Asranna, Keerthi Talari Bommakanti, Anuj Shukla, Arun K. Pande, Kunal Chandwar, Akanksha Ghodke, Hiya Boro, Zoha Zahid Fazal, Döndü Üsküdar Cansu, Reşit Yıldırım, Armen Yuri Gasparyan, Nicoletta Del Papa, Gianluca Sambataro, Fabiola Atzeni, Marcello Govoni, Simone Parisi, Elena Bartoloni Bocci, Gian Domenico Sebastiani, Enrico Fusaro, Marco Sebastiani, Luca Quartuccio, Franco Franceschini, Pier Paolo Sainaghi, Giovanni Orsolini, Rossella De Angelis, Maria Giovanna Danielli, Vincenzo Venerito, Silvia Grignaschi
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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 < 0.001) and autoimmune disease multimorbidity (AIDm) (P < 0.001).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.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 < 0.001). CONCLUSION: 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.