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 ¼ 0.403, P ¼ 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (P ¼ 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) ¼ 1.4; 95% CI: 1.1, 1.7; P ¼ 0.003), or a MHD (OR ¼ 1.7; 95% CI: 1.1, 2.6; P ¼ 0.007), or being a Moderna vaccine recipient (OR ¼ 1.5; 95% CI: 1.09, 2.2; P ¼ 0.014) were predictors of flares. Use of MMF (OR ¼ 0.5; 95% CI: 0.3, 0.8; P ¼ 0.009) and glucocorticoids (OR ¼ 0.6; 95% CI: 0.5, 0.8; P ¼ 0.003) were protective. A higher frequency of patients with AIRDs reported overall active disease post-vaccination compared with before vaccination (OR ¼ 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.
Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys / Jagtap, Kshitij; Naveen, R; Day, Jessica; Sen, Parikshit; Vaidya, Binit; Nune, Arvind; Nikiphorou, Elena; Lyn Tan, Ai; Agarwal, Vishwesh; Saha, Sreoshy; Katsuyuki Shinjo, Samuel; Ziade, Nelly; Joshi, Mrudula; Velikova, Tsvetelina; Milchert, Marcin; Parodis, Ioannis; Edgar Gracia-Ramos, Abraham; Cavagna, Lorenzo; Kuwana, Masataka; Knitza, Johannes; Makol, Ashima; Patel, Aarat; D Pauling, John; Wincup, Chris; Barman, Bhupen; Adrian Zamora Tehozol, Erick; Rojas Serrano, Jorge; García-De La Torre, Ignacio; J Colunga-Pedraza, Iris; Merayo-Chalico, Javier; Celestine Chibuzo, Okwara; Katchamart, Wanruchada; Akawatcharangura Goo, Phonpen; Shumnalieva, Russka; Chen, Yi-Ming; Santos Hoff, Leonardo; El Kibbi, Lina; Halabi, Hussein; Sazliyana Shaharir, Syahrul; M Tanveer Hasan, A T; Dey, Dzifa; Enrique Toro Gutiérrez, Carlos; Vinicio Caballero-Uribe, Carlo; B Lilleker, James; Salim, Babur; Gheita, Tamer; Chatterjee, Tulika; A Saavedra, Miguel; Distler, Oliver; Study Group, Covad; Chinoy, Hector; Agarwal, Vikas; Aggarwal, Rohit; Gupta COVAD Study Group: Zoltán Griger, Latika; Kardes, Sinan; Andreoli, Laura; Lini, Daniele; Schreiber, Karen; Nagy Vince, Melinda; Preet Singh, Yogesh; Ranjan, Rajiv; Jain, Avinash; C Pandya, Sapan; Kumar Pilania, Rakesh; Sharma, Aman; Manesh Manoj, M; Gupta, Vikas; G Kavadichanda, Chengappa; Sekhar Patro, Pradeepta; Ajmani, Sajal; Phatak, Sanat; Prosad Goswami, Rudra; Chandra Chowdhury, Abhra; Jacob Mathew, Ashish; Shenoy, Padnamabha; Asranna, Ajay; Talari Bommakanti, Keerthi; Shukla, Anuj; R Pande, Arunkumar; Chandwar, Kunal; Ghodke, Akanksha; Boro, Hiya; Zahid Fazal, Zoha; Üsküdar Cansu, Döndü; Yıldırım, Reşit; Yuri Gasparyan, Armen; Del Papa, Nicoletta; Sambataro, Gianluca; Fabiola, Atzeni; Govoni, Marcello; Parisi, Simone; Bartoloni Bocci, Elena; Domenico Sebastiani, Gian; Fusaro, Enrico; Sebastiani, Marco; Quartuccio, Luca; Franceschini, Franco; Paolo Sainaghi, Pier; Orsolini, Giovanni; DE ANGELIS, Rossella; Giovanna Danielli, Maria; Venerito, Vincenzo; Grignaschi, Silvia; Giollo, Alessandro; Alluno, Alessia; Ioannone, Florenzo; Fornaro, Marco; S Traboco, Lisa; Anggoro Kusumo Wibowo, Suryo; Loarce-Martos, Jesús; Prieto-González, Sergio; Aranega Gonzalez, Raquel; Yoshida, Akira; Nakashima, Ran; Sato, Shinji; Kimura, Naoki; Kaneko, Yuko; Gono, Takahisa; Tomaras, Stylianos; Nikolai Proft, Fabian; Holzer, Marie-Therese; Aleksandrovna Gromova, Margarita; Aharonov, Or; Griger, Zoltán; Hmamouchi, Ihsane; El Bouchti, Imane; Baba, Zineb; Giannini, Margherita; Maurier, François; Campagne, Julien; Meyer, Alain; Langguth, Daman; Limaye, Vidya; Needham, Merrilee; Srivastav, Nilesh; Hudson, Marie; Landon-Cardinal, Océane; Gerardo Rojas Zuleta, Wilmer; Arbeláez, Álvaro; Cajas, Javier; António Pereira Silva, José; Eurico Fonseca, João; Zimba, Olena; Bohdana, Doskaliuk; Ima-Edomwonyi, Uyi; Dedeke, Ibukunoluwa; Airenakho, Emorinken; Henry Madu, Nwankwo; Yerima, Abubakar; Olaosebikan, Hakeem; Becky, A; Devi Koussougbo, Oruma; Palalane, Elisa; So, Ho; Francisco Ugarte-Gil, Manuel; Chinchay, Lyn; Proaño Bernaola, José; Pimentel, Victorio; Mohammed Fathi, Hanan; A Mohammed, Reem Hamdy; Harifi, Ghita; Fuentes-Silva, Yurilís; Cabriza, Karoll; Losanto, Jonathan; Colaman, Nelly; Cachafeiro-Vilar, Antonio; Guerra Bautista, Generoso; Julio Giraldo Ho, Enrique; Stange Nunez, Lilith; Cristian Vergara, M; Then Báez, Jossiell; Alonzo, Hugo; Benito Santiago Pastelin, Carlos; García Salinas, Rodrigo; Quiñónez Obiols, Alejandro; Chávez, Nilmo; Bran Ordóñez, Andrea; Argueta, Sandra; Alberto Reyes Llerena, Gil; Sierra-Zorita, Radames; Arrieta, Dina; Romero Hidalgo, Eduardo; Saenz, Ricardo; Idania Escalante, M; Calapaqui, Wendy; Quezada, Ivonne; Gabriela,. - In: RHEUMATOLOGY. - ISSN 1462-0324. - 62:12(2023), pp. 3838-3848. [10.1093/rheumatology/kead144]
Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys
Rossella De Angelis;
2023-01-01
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 ¼ 0.403, P ¼ 0.022). Arthritis (61.6%) and fatigue (58.8%) were the most commonly reported symptoms. Self-reported flares were associated with higher comorbidities (P ¼ 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) ¼ 1.4; 95% CI: 1.1, 1.7; P ¼ 0.003), or a MHD (OR ¼ 1.7; 95% CI: 1.1, 2.6; P ¼ 0.007), or being a Moderna vaccine recipient (OR ¼ 1.5; 95% CI: 1.09, 2.2; P ¼ 0.014) were predictors of flares. Use of MMF (OR ¼ 0.5; 95% CI: 0.3, 0.8; P ¼ 0.009) and glucocorticoids (OR ¼ 0.6; 95% CI: 0.5, 0.8; P ¼ 0.003) were protective. A higher frequency of patients with AIRDs reported overall active disease post-vaccination compared with before vaccination (OR ¼ 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.File | Dimensione | Formato | |
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