COVID-19 vaccine not associated with increased autoimmune rheumatic disease flares
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In patients with autoimmune rheumatic diseases, vaccination against COVID-19 does not appear to correlate with increased flares, regardless of disease status, previous exposure and vaccine type, according to data published in Rheumatology.
“Autoimmune rheumatic diseases (AIRDs) are associated with increased risk of hospitalization and death from coronavirus disease 2019 (COVID-19),” Georgina Nakafero, PhD, of the University of Nottingham, in the United Kingdom, and colleagues wrote. “Despite this, only 54% patients with AIRDs were willing to get vaccinated against COVID-19 in the VAccinations against COVid-19 [VAXICOV] study, with vaccine willingness significantly lower in the younger age groups. In this study, vaccine hesitancy was driven by apprehension about novel mRNA vaccine technology and vaccination-induced disease flare.
“There is a paucity of data on the association between COVID-19 vaccination and AIRD flares as patients with these conditions were excluded from initial COVID-19 vaccination trials, potentially due to concerns about low vaccine efficacy,” they added.
To examine the link between COVID-19 vaccines and AIRD flare, Nakafero and colleagues conducted a self-controlled case series analysis using data from the Clinical Practice Research Datalink Aurum, which began collecting patient data in 1995. The database includes demographic information, lifestyle parameters, vaccinations received and data from primary care visits.
To be included in the analysis, participants needed to be 18 or older with one or more primary care visit for AIRD. For this study, AIRDs were defined as rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease-associated arthritis, reactive arthritis, ankylosing spondylitis, systemic lupus erythematosus, connective tissue disease, small-vessel vasculitis, giant cell arteritis or polymyalgia rheumatica.
Additionally, eligible patients were required to be prescribed one or more conventional disease-modifying antirheumatic drug prior to Dec. 1, 2020, have received one or more COVID-19 vaccination dose, and consulted a primary care provider for an autoimmune rheumatic disease flare during the study period.
The researchers collected data spanning Dec. 1, 2020, through Dec. 31, 2021. Data were censured if a patient died, left the practice or if the final data of collection occurred before Dec. 31, 2021. In addition, the researchers collected exposure data identifying vaccination against COVID-19, and different codes were used for different dates of vaccination and vaccination types. The main outcome of concern was AIRD flare, defined by the presence of diagnostic coding alongside a corticosteroid prescription.
The analysis included 3,554 cases of AIRDs. Of those, 68.3% were patients with RA. Vaccination against COVID-19 was associated with “significantly fewer” flares during the vaccination-exposed period of 21 days, the researchers wrote (adjusted IRR = 0.89; 95% CI, 0.8-0.98). Additionally, there was a negative association during the 21-day period following the first COVID-19 vaccine dose, but not during subsequent doses (aIRR = 0.76; 95% CI, 0.66-0.89).
“Vaccination against COVID-19 was not associated with AIRD flare, and vaccination with or without prior COVID-19, and with either mRNA or vectored DNA vaccines, were not associated with AIRD flares,” Nakafero and colleagues wrote. “These data should address the apprehension of disease specific adverse effects from COVID-19 vaccination, an important reason for vaccine hesitancy in AIRDs, that may become even more significant as a barrier against vaccination as the perceived benefit from booster vaccination reduces.”
References:
Felton R, et al. Lancet Rheumatol. 2021;doi: 10.1016/S2665-9913(21)00039-4.
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