Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys
1
Issued Date
2023-12-01
Resource Type
eISSN
14620332
Scopus ID
2-s2.0-85178648976
Pubmed ID
36961331
Journal Title
Rheumatology (Oxford, England)
Volume
62
Issue
12
Start Page
3838
End Page
3848
Rights Holder(s)
SCOPUS
Bibliographic Citation
Rheumatology (Oxford, England) Vol.62 No.12 (2023) , 3838-3848
Suggested Citation
Jagtap K., Naveen R., Day J., Sen P., Nune B.V.A., Nikiphorou E., Tan A.L., Saha V.A.S., Shinjo S.K., Ziade N., Velikova M.J.T., Milchert M., Parodis I., Gracia-Ramos A.E., Cavagna L., Knitza M.K.J., Makol A., Patel A., Pauling J.D., Barman C.W.B., Tehozol E.A.Z., Garcıa-De La Torre J.R.S.I., Colunga-Pedraza I.J., Merayo-Chalico Okwara Celestine Chibuzo J., Katchamart W., Goo P.A., Shumnalieva R., Chen Y.M., Hoff L.S., Halabi L.E.K.H., Shaharir S.S., Hasan A.T.M.T., Gutiérrez D.D.C.E.T., Caballero-Uribe C.V., Lilleker Babur Salim J.B., Gheita T., Chatterjee T., Saavedra Oliver Distler M.A., Chinoy H., Aggarwal V.A.R., Gupta L. Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys. Rheumatology (Oxford, England) Vol.62 No.12 (2023) , 3838-3848. 3848. doi:10.1093/rheumatology/kead144 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/91473
Title
Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys
Author(s)
Jagtap K.
Naveen R.
Day J.
Sen P.
Nune B.V.A.
Nikiphorou E.
Tan A.L.
Saha V.A.S.
Shinjo S.K.
Ziade N.
Velikova M.J.T.
Milchert M.
Parodis I.
Gracia-Ramos A.E.
Cavagna L.
Knitza M.K.J.
Makol A.
Patel A.
Pauling J.D.
Barman C.W.B.
Tehozol E.A.Z.
Garcıa-De La Torre J.R.S.I.
Colunga-Pedraza I.J.
Merayo-Chalico Okwara Celestine Chibuzo J.
Katchamart W.
Goo P.A.
Shumnalieva R.
Chen Y.M.
Hoff L.S.
Halabi L.E.K.H.
Shaharir S.S.
Hasan A.T.M.T.
Gutiérrez D.D.C.E.T.
Caballero-Uribe C.V.
Lilleker Babur Salim J.B.
Gheita T.
Chatterjee T.
Saavedra Oliver Distler M.A.
Chinoy H.
Aggarwal V.A.R.
Gupta L.
Naveen R.
Day J.
Sen P.
Nune B.V.A.
Nikiphorou E.
Tan A.L.
Saha V.A.S.
Shinjo S.K.
Ziade N.
Velikova M.J.T.
Milchert M.
Parodis I.
Gracia-Ramos A.E.
Cavagna L.
Knitza M.K.J.
Makol A.
Patel A.
Pauling J.D.
Barman C.W.B.
Tehozol E.A.Z.
Garcıa-De La Torre J.R.S.I.
Colunga-Pedraza I.J.
Merayo-Chalico Okwara Celestine Chibuzo J.
Katchamart W.
Goo P.A.
Shumnalieva R.
Chen Y.M.
Hoff L.S.
Halabi L.E.K.H.
Shaharir S.S.
Hasan A.T.M.T.
Gutiérrez D.D.C.E.T.
Caballero-Uribe C.V.
Lilleker Babur Salim J.B.
Gheita T.
Chatterjee T.
Saavedra Oliver Distler M.A.
Chinoy H.
Aggarwal V.A.R.
Gupta L.
Author's Affiliation
Faculty of Medicine and Health
Siriraj Hospital
UCL Division of Medicine
Graduate School of Medicine
Faculty of Biology, Medicine and Health
Bristol Medical School
NIHR Leeds Biomedical Research Centre
Southport and Ormskirk Hospital NHS Trust
Manchester University NHS Foundation Trust
Pontificia Universidad Javeriana, Cali
Seth GS Medical College and KEM Hospital
Fauji Foundation Hospital
Hospital General de Occidente
Hôtel-Dieu de France Hospital
Université Saint-Joseph de Beyrouth
Universidad del Norte
Ministry of Health and Family Welfare
University of Virginia School of Medicine
Sveti Ivan Rilski hospital
Universitätsklinikum Erlangen
Universidade Potiguar
North Bristol NHS Trust
Walter and Eliza Hall Institute of Medical Research
University of Melbourne
University of Nigeria
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Faculty of Medicine
University of Leeds, School of Medicine
University of Illinois College of Medicine
University College London
Mymensingh Medical College
King's College Hospital
Sofia University St. Kliment Ohridski
UniversitatsSpital Zurich
Karolinska Universitetssjukhuset
UMAE Hospital de Especialidades Centro Medico Nacional Siglo XXI
Pomeranian Medical University in Szczecin
Hospital Universitario Dr. Jose Eleuterio Gonzalez
University of Ghana
King Faisal Specialist Hospital and Research Centre
Università degli Studi di Pavia
King's College London
Maulana Azad Medical College
Instituto Nacional de la Nutrición Salvador Zubiran
Salford Royal NHS Foundation Trust
Instituto Mexicano del Seguro Social
Instituto Nacional de Enfermedades Respiratorias
Universidade de São Paulo
Birmingham City Hospital
The Royal Wolverhampton NHS Trust
Veterans General Hospital-Taichung Taiwan
Mayo Clinic
Royal Melbourne Hospital
Salford Royal Hospital
University of Pittsburgh School of Medicine
Faculty of Medicine, UKM
Queen Savang Vadhana Memorial Hospital
National Center for Rheumatic Diseases
Specialized Medical Center
Enam Medical College and Hospital
Mahatma Gandhi Mission Medical College
Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
Siriraj Hospital
UCL Division of Medicine
Graduate School of Medicine
Faculty of Biology, Medicine and Health
Bristol Medical School
NIHR Leeds Biomedical Research Centre
Southport and Ormskirk Hospital NHS Trust
Manchester University NHS Foundation Trust
Pontificia Universidad Javeriana, Cali
Seth GS Medical College and KEM Hospital
Fauji Foundation Hospital
Hospital General de Occidente
Hôtel-Dieu de France Hospital
Université Saint-Joseph de Beyrouth
Universidad del Norte
Ministry of Health and Family Welfare
University of Virginia School of Medicine
Sveti Ivan Rilski hospital
Universitätsklinikum Erlangen
Universidade Potiguar
North Bristol NHS Trust
Walter and Eliza Hall Institute of Medical Research
University of Melbourne
University of Nigeria
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Faculty of Medicine
University of Leeds, School of Medicine
University of Illinois College of Medicine
University College London
Mymensingh Medical College
King's College Hospital
Sofia University St. Kliment Ohridski
UniversitatsSpital Zurich
Karolinska Universitetssjukhuset
UMAE Hospital de Especialidades Centro Medico Nacional Siglo XXI
Pomeranian Medical University in Szczecin
Hospital Universitario Dr. Jose Eleuterio Gonzalez
University of Ghana
King Faisal Specialist Hospital and Research Centre
Università degli Studi di Pavia
King's College London
Maulana Azad Medical College
Instituto Nacional de la Nutrición Salvador Zubiran
Salford Royal NHS Foundation Trust
Instituto Mexicano del Seguro Social
Instituto Nacional de Enfermedades Respiratorias
Universidade de São Paulo
Birmingham City Hospital
The Royal Wolverhampton NHS Trust
Veterans General Hospital-Taichung Taiwan
Mayo Clinic
Royal Melbourne Hospital
Salford Royal Hospital
University of Pittsburgh School of Medicine
Faculty of Medicine, UKM
Queen Savang Vadhana Memorial Hospital
National Center for Rheumatic Diseases
Specialized Medical Center
Enam Medical College and Hospital
Mahatma Gandhi Mission Medical College
Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
Other Contributor(s)
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.