Breakthrough COVID-19 infection risk highest in RA, gout, polydermatomyositis, vasculitis
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Patients with rheumatoid arthritis, gout, polydermatomyositis, vasculitis and those with multiple rheumatic diseases were at greatest risk for breakthrough COVID-19 infection, despite full or partial vaccination vs. those without rheumatic disease.
“The objective of our study was to evaluate whether patients with autoimmune or inflammatory rheumatic diseases and their treatments are associated with a higher risk of post-vaccine breakthrough COVID-19 infections compared to non-immunocompromised or compromised patients,” Jasvinder A. Singh, MD, MPH, of the University of Alabama at Birmingham, said in his presentation at ACR Convergence 2021.
Data were culled from the U.S. National COVID Cohort Collaborative and included case patients and controls that were accrued from January 2020 through September 2021. Eligibility criteria for cases included an ICD-10 code diagnosis of RA, spondyloarthritis, gout, systemic lupus erythematosus, systemic sclerosis, polymyositis, polymyalgia rheumatica (PMR) and/or rheumatoid lung or multiple rheumatic diseases.
Categories of medication also underwent analysis. These included biologic or non-biologic disease-modifying anti-rheumatic drugs, TNF inhibitors, therapies targeting interleukin-1, IL-6, IL-23, glucocorticoids, various immunosuppressants, colchicine and urate lowering therapies (ULT).
Breakthrough infection 14 or more days after full or partial COVID-19 vaccination served as the primary endpoint. The group defined full vaccination as two doses of an mRNA vaccine or one dose of the Johnson & Johnson product.
The final statistical analysis was comprised of 577,335 patients, with 514,888 individuals having no rheumatic or autoimmune diseases.
Singh reported that 91% of the cohort was fully vaccinated, while 9% were partially vaccinated. Roughly 70% of the group had received the Pfizer vaccine.
“The rate of breakthrough infections was 3% in people without rheumatic diseases and varies between 3% and 5% for various rheumatic diseases,” he said.
For the Pfizer vaccine, the prevalence of breakthrough infections was 31.16 per 1,000 individuals among those without rheumatic diseases and 41.46 per 1,000 for those with rheumatic diseases. For the Moderna product, the rates were 26.52 breakthroughs per 1,000 in the non-rheumatic disease group and 35.65 per 1,000 for the rheumatic disease group.
The analysis also included disease-specific information. “People with rheumatoid arthritis, gout, polydermatomyositis, vasculitis and multiple rheumatic diseases were significantly more likely to have breakthrough infections compared to people without immunosuppressed conditions,” Singh said.
The trend for these diseases persisted through multivariable analysis, according to Singh.
Drug-specific data showed that biologic therapies and multiple autoimmune or rheumatic disease drugs carried the greatest risk for breakthrough infection, according to findings from the multivariable analysis. “More recent exposure was associated with higher odds [of breakthrough infection],” Singh said.
“This data, we believe, is important information to guide patients, providers and policymakers,” he concluded. “Although more research is needed . . . these findings support the use of a third vaccination in immunosuppressed patients.”
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Singh J. Abstract L16. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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