Session 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.
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 September 25, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sars-cov-2-infections-among-vaccinated-individuals-with-rheumatic-disease-results-from-the-covid-19-global-rheumatology-alliance-provider-registry/