Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys

Jagtap K, Naveen R, Day J, Sen P, Vaidya B, Nune A, Nikiphorou E, Tan AL, Agarwal V, Saha S, Shinjo SK, Ziade N, Joshi M, Velikova T, Milchert M, Parodis I, Edgar Gracia-Ramos A, Cavagna L, Kuwana M, Knitza J, Makol A, Patel A, Pauling JD, Wincup C, Barman B, Zamora Tehozol EA, Rojas Serrano J, García-De La Torre I, Colunga-Pedraza IJ, Merayo-Chalico J, Chibuzo OC, Katchamart W, Goo PA, Shumnalieva R, Chen YM, Hoff LS, El Kibbi L, Halabi H, Sazliyana Shaharir S, Hasan AT, Dey D, Gutiérrez CET, Caballero-Uribe CV, Lilleker JB, Salim B, Gheita T, Chatterjee T, Saavedra MA, Distler O, Chinoy H, Agarwal V, Aggarwal R, Gupta L (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 62

Pages Range: 3838-3848

Journal Issue: 12

DOI: 10.1093/rheumatology/kead144

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.

Authors with CRIS profile

Involved external institutions

University of Manchester United Kingdom (GB) Fauji Foundation Hospital Pakistan (PK) University of Illinois at Chicago United States (USA) (US) Centro Medico Nacional Siglo XXI Mexico (MX) Universitätsspital Zürich (USZ) Switzerland (CH) Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) India (IN) Enam Medical College & Hospital (EMCH) / এনাম মেডিকেল কলেজ ও হাসপাতাল Bangladesh (BD) University of Ghana Ghana (GH) Pontifical Xavierian University / Pontificia Universidad Javeriana Colombia (CO) Universidade Potiguar (UnP) Brazil (BR) King Faisal Specialist Hospital & Research Centre Saudi Arabia (SA) University of Malaya (UM) / Universiti Malaya Malaysia (MY) Universidad del Norte Colombia (CO) Maulana Azad Medical College (MAMC) India (IN) National Center for Rheumatic Diseases (NCRD) Nepal (NP) University of São Paulo / Universidade de São Paulo (USP) Brazil (BR) Southport and Ormskirk Hospital NHS Trust United Kingdom (GB) Université Saint-Joseph (USJ) / جامعة القديس يوسف / Սուրբ Ժոզեֆի համալսարան Lebanon (LB) Byramjee Jeejeebhoy Government Medical College & Sassoon General Hospital India (IN) Sofia University "St. Kliment Ohridski" / Софийски университет "Св. Климент Охридски" Bulgaria (BG) Pomeranian Medical University / Pomorski Uniwersytet Medyczny w Szczecinie (PMU) Poland (PL) Karolinska University Hospital / Karolinska Universitetssjukhuset Sweden (SE) Instituto Mexicano del Seguro Social Mexico (MX) Mayo Clinic United States (USA) (US) University of Virginia (UVA) United States (USA) (US) University of Bristol United Kingdom (GB) University College London (UCL) United Kingdom (GB) University of Pittsburgh United States (USA) (US) Instituto Nacional de Enfermedades Respiratorias Mexico (MX) Hospital General de Occidente (HGO) Mexico (MX) Università degli Studi di Pavia Italy (IT) King’s College London United Kingdom (GB) NIHR Leeds Musculoskeletal Biomedical Research Unit (LMBRU) United Kingdom (GB) Mahatma Gandhi Mission Medical College and Hospital India (IN) Mymensingh Medical College / ময়মনসিংহ মেডিকেল কলেজ Bangladesh (BD) Hospital Universitario Dr José Eleuterio Gonzalez Mexico (MX) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico (MX) University of Nigeria Nigeria (NG) Siriraj Hospital Thailand (TH) Queen Savang Vadhana Memorial Hospital / โรงพยาบาลสมเด็จพระบรมราชเทวี ณ ศรีราชา Thailand (TH) University Hospital St. Ivan Rilski Bulgaria (BG) Taichung Veterans General Hospital Taiwan (TW) King Edward Memorial Hospital and Seth G.S. Medical College / கிங் எட்வர்ட் நினைவு மருத்துவமனை,राजा एड्वर्ड स्मारक रुग्णालय व सेठ गोवर्धनदास सुंदरदास वैद्यकीय महाविद्यालय India (IN) Walter and Eliza Hall Institute of Medical Research (WEHI) Australia (AU)

How to cite

APA:

Jagtap, K., Naveen, R., Day, J., Sen, P., Vaidya, B., Nune, A.,... Gupta, L. (2023). Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys. Rheumatology, 62(12), 3838-3848. https://dx.doi.org/10.1093/rheumatology/kead144

MLA:

Jagtap, Kshitij, et al. "Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys." Rheumatology 62.12 (2023): 3838-3848.

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