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