One in 10 patients with autoimmune rheumatic disease flared after COVID-19 vaccination
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Key takeaways:
- Patients with comorbidities and mental health disorders were more likely to experience flare after vaccination.
- As many as one in three patients are at risk for flares following COVID-19 infection.
Nearly 10% of patients with autoimmune rheumatic disease experience flares following COVID-19 vaccination, according to data published in Rheumatology.
“Disease flares are one of the prominent concerns that patients with rheumatic diseases have, as these episodes are often accompanied by disabling symptoms that affect their day-to-day activities and quality of life,” Kshitij Jagtap, MD, of the Seth Gordhandas Sunderdas Medical College, in Mumbai, India, Parikshit Sen, MBBS, of Maulana Azad Medical College, in New Delhi, India, and Latika Gupta, MD, of the University of Manchester, in the United Kingdom, told Healio in a joint statement.
“This has been one of the reasons why many of these patients are reluctant to get vaccinated against COVID-19, as there is a lingering fear that vaccines may precipitate these flares,” they added. “Unfortunately, there were very few studies that had investigated this relationship between COVID-19 vaccines and disease flares and thus there was no credible data to alleviate these concerns.”
To investigate the patterns of disease flares in patients who are vaccinated against COVID-19, Jagtap, Sen, Gupta and colleagues conducted the COVAD 1 and COVAD 2 multinational, cross-sectional, patient-reported electronic surveys. COVAD 1 was conducted in 2021, while COVAD 2 was conducted in 2022. Each included 36 questions regarding COVID-19 and the autoimmune rheumatic disease state of each patient. Participants were asked to clarify demographic information, as well as the type of disease they had, length of disease, clinical symptoms and their current medications.
The researchers extracted data in May and June of 2022. Patients were excluded from the analysis if they were vaccinated in mid-2020, had nonrheumatic autoimmune diseases, were healthy respondents or were unvaccinated. Flares were defined and categorized in four ways — patient-reported flares, flares suggested by increased immunosuppression ordered by a physician, those suggested by new clinical signs or exacerbations, and a 7.9-point worsening of PROMIS scores between the patients who had taken both surveys.
There were 3,453 responses to the survey from patients with autoimmune rheumatic diseases. According to the researchers, the rate of patient-reported flares was 11.3%. Meanwhile, the rate flares suggested by ordered immunosuppression was was 14.8%, the rate of flares suggested by new markers was 9.5%, and the rate of flares based on worsening PROMIS scores between the surveys was 26.7%.
The most common reported symptoms were arthritis (61.6%) and fatigue (58.8%). In addition, flares that were self-reported appeared to be associated with more comorbidities (P = .013), mental health disorders (P < .001) and autoimmune multimorbidity (P < .001).
In the regression analysis, autoimmune multimorbidity (OR=1.4; 95% CI, 1.1- 1.7), a mental health disorder (OR=1.7; 95% CI, 1.1-2.6) or receiving the Moderna vaccine (OR=1.5; 95% CI, 1.09- 2.2) predicted flares. Meanwhile, the use of mycophenolate mofetil and (OR=0.5; 95% CI, 0.3-0.8) and glucocorticoids (OR=0.6; 95% CI, 0.5-0.8) among patients were protective, according to the researchers.
“We did find nearly one in 10 patients to experience a flare in the period after taking the vaccine,” Gupta, Sen and Jagtap said. “However, additional analysis from our study (in press) identified that one in three individuals are at risk of flares after COVID infection, reiterating the importance of timely vaccination. We have also found that certain groups may be vulnerable to severe breakthrough infections, and even though they may not always be symptomatic, yet the risk of being hospitalized and requiring intensive care may be higher.”
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