SARS-CoV-2 Infections Among Vaccinated Individuals with Rheumatic Disease: Results from the COVID-19 Global Rheumatology Alliance Provider Registry

Jean Liew¹, milena Gianfrancesco², Carly Harrison³, zara Izadi², Stephanie Rush², Lindsay Jacobsohn², Clairissa Ja², Saskia Lawson-Tovey⁴, Kimme Hyrich⁵, Laure Gossec⁶, Anja Strangfeld⁷, Loreto Carmona⁸, Martin Schaefer⁷, ELSA MATEUS⁹, Samar Al Emadi¹⁰, Claire Cook¹¹, Fatemah Abutiban¹², Dfiza Dey¹³, Emily Kowalski¹⁴, Marco Martinez-Martinez¹⁵, Naomi Patel¹¹, Evelyn Salido¹⁶, Jeffrey Sparks¹⁷, leanna Wise¹⁸, Suleman Bhana¹⁹, Wendy Costello²⁰, Rebecca Grainger²¹, Jonathan Hausmann²², Emily Sirotich²³, Paul Sufka²⁴, Zachary Wallace²⁵, Pedro Machado²⁶, Philip Robinson²⁷ and Jinoos Yazdany², ¹Boston University School of Medicine, Boston, MA, ²University of California San Francisco, San Francisco, CA, ³Lupus Chat, New York, NY, ⁴Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom, ⁵Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom, ⁶INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France, Paris, France, ⁷German Rheumatism Research Center (DRFZ Berlin), Epidemiology and Health Care Research, Berlin, Germany, ⁸Instituto de Salud Musculoesquelética, Madrid, Spain, ⁹EULAR, Lisboa, Portugal, ¹⁰Hamad Medical Corporation, Doha, Qatar, ¹¹Massachusetts General Hospital, Boston, MA, ¹²Rheumatology Unit, Department of Medicine, Jaber Alahmed Alsabah Hospital, KUWAIT, Kuwait, ¹³Rheumatology Unit , Department of Medicine and Therapeutics, University of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Ghana, ¹⁴Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, ¹⁵Instituto Mexicano del Seguro Social, San Luis Potosí, Mexico, ¹⁶University of the Philippines Manila, Manila, Philippines, ¹⁷Brigham and Women's Hospital, Boston, MA, ¹⁸University of Southern California, Los Angeles, CA, ¹⁹Pfizer, Montvale, NJ, ²⁰Irish Children's Arthritis Network (iCAN), Bansha, Ireland, ²¹University of Otago, Wellington, New Zealand, ²²Boston Childrens Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, ²³McMaster University, Hamilton, ON, Canada, ²⁴HealthPartners, Eagan, MN, ²⁵Massachusetts General Hospital, Harvard Medical School, Boston, MA, ²⁶Centre for Rheumatology & Department of Neuromuscular Diseases, University College London; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom, ²⁷University of Queensland School of Clinical Medicine, Herston, Queensland; Department of Rheumatology, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Queensland, Australia., Brisbane, Australia

Meeting: ACR Convergence 2021

Date of first publication: October 22, 2021

Keywords: COVID-19, Epidemiology, Late-Breaking 2021

Session Information

Title: Late-Breaking Posters (L01 - L15)

Session Type: Poster Session D

Background/Purpose: While COVID-19 vaccinations are a critical tool to prevent severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analyzed clinical characteristics of patients reported to the COVID-19 Global Rheumatology Alliance registry who developed COVID-19 after vaccination against SARS-CoV-2.

Methods: We included individuals partially or fully vaccinated against SARS-CoV-2, who had SARS-CoV-2 infection between January 5, 2021 and August 27, 2021. We analyzed patients’ demographic and clinical characteristics, and COVID-19 symptoms and outcomes. Partially vaccinated was defined as being ≥14 days after the first dose in a 2-dose series or within 13 days of a single-dose vaccine. Fully vaccinated was defined as infection occurring ≥14 days after the second dose in a 2-dose series or 2 weeks after a single-dose vaccine. We excluded those who were within 14 days of their first dose of a 2-dose series. Among the fully vaccinated, we described baseline medications and outcomes, and included additional clinical details for those who were hospitalized.

Results: We included 115 partially or fully vaccinated individuals with rheumatic disease who developed SARS-CoV-infection (mean age 53 years, 73% female, 58% White) (Table 1). The most common rheumatic diseases were RA (43.5%), SLE (13%) and PsA (10%); 20% had moderate/high disease activity. The most common comorbidities were hypertension (30%), lung disease (21%), and obesity (19%). The majority (59%) received mRNA vaccines. The most common COVID-19 symptoms were cough (65%), fever (54%), and malaise (36%); 7% reported no symptoms. Among the fully vaccinated (n=39), infection occurred a mean of 86.5 (+/- 58.24) days after the second dose, and 29% were hospitalized. Eleven (28%) were on methotrexate, 11 (28%) were on B cell-depleting therapies (BCDT), 11 (28%) were on other antimetabolites, and 5 (23%) were on other biologic DMARDs. The majority (67%) were not taking systemic glucocorticoids. All but two cases continued their antirheumatic medications before or after their vaccine doses. Of those fully vaccinated and hospitalized (n=11; age range 36-71 years), six had pre-existing lung disease and two had no reported comorbidities (Table 2). Two patients with comorbid lung disease subsequently died (one requiring non-invasive and the other requiring invasive mechanical ventilation).

Conclusion: The majority of fully vaccinated individuals with breakthrough infections in this series were on anti-metabolites or BCDT. Additional strategies, including additional vaccine doses, medication interruption, and monoclonal antibody pre-and post-exposure prophylaxis may be needed to protect this high-risk population.

+Cases could have more than one disease diagnosis
^Conventional synthetic DMARD (csDMARD) medications included: antimalarials (hydroxychloroquine, chloroquine), azathioprine, cyclophosphamide, cyclosporine, leflunomide, methotrexate, mycophenolate mofetil/mycophenolic acid, sulfasalazine, tacrolimus; Biologic or targeted synthetic DMARDs (b/tsDMARD) included: abatacept, belimumab, CD_20 inhibitors, IL_1 inhibitors, IL-6 inhibitors, IL_12/23 inhibitors, IL_17 inhibitors, anti-TNF, and Janus-kinase inhibitors
#Confirmed COVID_19 diagnosis: Diagnosis made via PCR, antigen, or antibody test.
*Fully vaccinated: infection >14 days after 2nd dose of two dose vaccine, or 1st if Janssen/Johnson & Johnson

*Patient was B-cell depleted at the time of vaccination
Abbreviations: BCDT, B cell depleting therapy; MMF, mycophenolate mofetile/mycophenolic acid

J. Liew, None; m. Gianfrancesco, Picnic Health, 2; C. Harrison, None; z. Izadi, None; S. Rush, None; L. Jacobsohn, None; C. Ja, None; S. Lawson-Tovey, None; K. Hyrich, Abbvie, 6, Pfizer, 5, BMS, 5; L. Gossec, AbbVie, 2, Amgen, 2, 5, BMS, 2, Biogen, 2, Celgene, 2, Gilead, 2, Janssen, 2, 5, Lilly, 2, 5, Novartis, 2, Pfizer, 2, 5, Samsung Bioepis, 2, UCB, 2, Sanofi, 2, 5, Sandoz, 5, Galapagos, 5; A. Strangfeld, AbbVie, 6, Pfizer, 6, BMS, 6, Lilly, 6, Roche, 6, Celltrion, 6; L. Carmona, Pfizer, 12, My Institute provides services; M. Schaefer, None; E. MATEUS, None; S. Al Emadi, None; C. Cook, None; F. Abutiban, None; D. Dey, None; E. Kowalski, None; M. Martinez-Martinez, None; N. Patel, None; E. Salido, None; J. Sparks, AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Inova Diagnostics, Optum, and Pfizer, 2; l. Wise, Aurinia Pharma, 2, 6; S. Bhana, AbbVie, 2, Novartis, 2, Pfizer, 2, Horizon, 2; W. Costello, None; R. Grainger, AbbVie, 2, Janssen, 2, Novartis, 2, Pfizer, 2, Cornerstones, 2; J. Hausmann, Childhood Arthritis and Rheumatology Research Alliance (CARRA) and Rheumatology Research Alliance, 5, Novartis, Pfizer, and Biogen, 12, personal fees; E. Sirotich, None; P. Sufka, None; Z. Wallace, Principia/Sanofi & BMS, 5, Viela Bio and MedPace, 12, personal fees; P. Machado, AbbVie, 2, BMS, 2, Celgene, 2, Eli Lilly, 2, Janssen, 2, MSD, 2, Novartis, 2, Pfizer, 2, Roche, 2, UCB, 2, Orphazyme, 2; P. Robinson, AbbVie, 2, Eli Lilly, 2, Janssen, 2, Novartis, 2, Pfizer, 2, UCB, 2, Roche, 12; J. Yazdany, Eli LIlly, 2, Pfizer, 2, Aurinia, 2, AstraZeneca, 2.

To cite this abstract in AMA style:

Liew J, Gianfrancesco m, Harrison C, Izadi z, Rush S, Jacobsohn L, Ja C, Lawson-Tovey S, Hyrich K, Gossec L, Strangfeld A, Carmona L, Schaefer M, MATEUS E, Al Emadi S, Cook C, Abutiban F, Dey D, Kowalski E, Martinez-Martinez M, Patel N, Salido E, Sparks J, Wise l, Bhana S, Costello W, Grainger R, Hausmann J, Sirotich E, Sufka P, Wallace Z, Machado P, Robinson P, Yazdany J. SARS-CoV-2 Infections Among Vaccinated Individuals with Rheumatic Disease: Results from the COVID-19 Global Rheumatology Alliance Provider Registry [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/sars-cov-2-infections-among-vaccinated-individuals-with-rheumatic-disease-results-from-the-covid-19-global-rheumatology-alliance-provider-registry/. Accessed .

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