J Autoimmun . Post-mRNA vaccine flares in autoimmune inflammatory rheumatic diseases: Results from the COronavirus National Vaccine registry for ImmuNe diseases SINGapore (CONVIN-SING)

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J Autoimmun


. 2022 Nov 29;134:102959.
doi: 10.1016/j.jaut.2022.102959. Online ahead of print.
Post-mRNA vaccine flares in autoimmune inflammatory rheumatic diseases: Results from the COronavirus National Vaccine registry for ImmuNe diseases SINGapore (CONVIN-SING)


Margaret Ma ¹ , Amelia Santosa ¹ , Warren Fong ² , Li-Ching Chew ² , Andrea Hl Low ² , Annie Law ³ , Yih Jia Poh ⁴ , Siaw Ing Yeo ⁴ , Ying Ying Leung ³ , Victoria Ww Ng ⁵ , Joshua Ze Koh ⁵ , Sen Hee Tay ¹ , Anselm Mak ¹ , Gim Gee Teng ⁶ , Chuanhui Xu ⁷ , Johnston Gx Tang ⁷ , Kok Ooi Kong ⁷ , Stanley Angkodjojo ⁸ , Wei-Rui Goh ⁸ , Tyng Yu Chuah ⁸ , Nur Emillia Roslan ⁸ , Thaschawee Arkachaisri ⁹ , Kai Liang Teh ¹⁰ , Melonie Sriranganathan ¹¹ , Teck Choon Tan ¹² , Kee Fong Phang ¹³ , Qai Ven Yap ¹⁴ , Yiong Huak Chan ¹⁴ , Peter Pm Cheung ¹ , Manjari Lahiri ¹⁵



Affiliations

• PMID: 36473406
• DOI: 10.1016/j.jaut.2022.102959

Abstract

Background: Studies of flares of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination are limited by small sample size, short follow up or at risk of selection bias.
Methods: A national retrospective cohort study of consecutive AIIRD patients ≥12 years old, across 8 hospitals who received at least one dose of a COVID-19 mRNA vaccine. Patients were included from the date of 1st vaccine dose and censored at the time of flare or on the date of the clinic visit at least 3 months from cohort entry, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis.
Findings: 4627 patients (73% Chinese, 71% female) of median (IQR) age 61 (48, 70) years were included; 42% Rheumatoid arthritis, 14% Systemic lupus erythematosus and 11% Psoriatic arthritis. 47% were in remission, 41% low disease activity, 10% moderate disease activity and 1% in high disease activity. 18% patients flared, of which 11.7% were within the 3-month period of interest. 11.8% patients improved. Median (IQR) time-to-flare was 60 (30, 114) days. 25% flares were self-limiting, 61% mild-moderate and 14% severe. Older patients (53-65 years and >66 years) had a lower risk of flare [HR 0.6 (95% CI 0.5-0.8) and 0.7 (0.6-0.8) respectively]. Patients with inflammatory arthritis and with active disease had a higher risk of flare [HR 1.5 (1.2-2.0) and 1.4 (1.2-1.6), respectively]. Treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), immunosuppression and prednisolone was also associated with an increased risk of flare [HR 1.5 (1.1-2), 1.2 (1.1-1.4) and 1.5 (1.2-1.8) for prednisolone ≤7.5 mg respectively].
Interpretation: There was a moderately high rate of AIIRD flares after mRNA vaccination but also improvement in several patients. Severe flares and hospitalisation were rare. Thus, vaccination remains safe and highly recommended.

Keywords: Autoimmune inflammatory rheumatic diseases; COVID vaccines; Registry.