Rheumatic disease activity at time of COVID-19 vaccination drives subsequent flare risk
Click Here to Manage Email Alerts
Key takeaways:
- Post-vaccination flare risk increased with disease activity or medication changes at the time of vaccination.
- Exposure to methotrexate, TNF inhibitors or rituximab protected against flare.
Higher disease activity and medication reduction at COVID-19 vaccination increase the risk for subsequent flares in patients with rheumatic and musculoskeletal diseases, according to data published in Annals of the Rheumatic Diseases.
“The COVID-19 pandemic caused unprecedented pressure on healthcare systems and resulted in a dramatic loss of human life worldwide,” Bayram Farisogullari, MD, of University College London, and colleagues wrote. “The development of highly effective vaccines against SARS-CoV-2 changed the course of the pandemic, with many lives saved by immunization against SARS-CoV-2, including the lives of patients with inflammatory/autoimmune rheumatic and musculoskeletal diseases (I-RMDs).
“The possibility of I-RMD flares has raised concerns, not only because there might be specific demographic or clinical features associated with increased risk of post-vaccination flare, but also because some organizations have recommended conventional and targeted synthetic disease-modifying antirheumatic drugs (cs/tsDMARDs) to be withheld ‘for 1 to 2 weeks (as disease activity allows) after each COVID-19 vaccine dose,’ a strategy that could contribute to increased frequency of post-vaccination I-RMD flares,” they added.
To assess disease flares following COVID-19 vaccination in patients with inflammatory or autoimmune rheumatic and musculoskeletal diseases, Farisogullari and colleagues analyzed data from the EULAR Coronavirus Vaccine physician-reported registry. Their analysis included 7,336 patients (mean age, 58.3 years), of whom 71% demonstrated inflammatory joint diseases, 18% had connective tissue diseases and 9.4% had vasculitis. The researchers used multivariable logistic regression to examine connections between demographic and clinical factors and post-vaccination flare.
Overall, 272 patients experienced flares (3.7%), with 121 (1.6%) exhibiting flares that required starting a new medication or increasing their current dosage.
Compared with patients in remission, those with low disease activity (OR = 1.45; 95% CI, 1.08-1.94) or moderate/high disease activity (OR = 1.37; 95% CI, 0.97-1.95) demonstrated an increased risk for flare, according to the researchers.
Patients were also at increased risk for flare if they had stopped or reduced antirheumatic medication before or after vaccination (OR = 4.76; 95% CI, 3.44-6.58). Meanwhile, the chance of flare was lower among patients exposed to methotrexate (OR = 0.57; 95% CI, 0.37-0.90), TNF inhibitors (OR = 0.55; 95% CI, 0.36-0.85) or rituximab (Rituxan, Genentech) (OR = 0.27; 95% CI, 0.11-0.66), compared with those on no antirheumatic treatment.
“Our findings suggest that disease flare following SARS-CoV-2 vaccination in individuals with immune-mediated rheumatic diseases (I-RMDs) is uncommon,” Farisogullari and colleagues wrote. “Higher disease activity and cessation/reduction of antirheumatic medications before or after vaccination were associated with an increased probability of flare, while exposure to certain medications such as methotrexate and rituximab was associated with a decreased probability of flare.
“These findings will assist patients, clinicians and other healthcare professionals in making informed decisions regarding the management of I-RMDs in the context of SARS-CoV-2 vaccination and contribute to the development of the most appropriate vaccination strategies for patients with I-RMDs,” they added.
Collapse
Read more about
Click Here to Manage Email Alerts