Factors associated with COVID-19 breakthrough infection among vaccinated patients with rheumatic diseases: A cohort study.
Semin Arthritis Rheum
; 58: 152108, 2022 Oct 26.
Article
in English
| MEDLINE | ID: covidwho-2234223
ABSTRACT
OBJECTIVE:
Rheumatic disease patients on certain immunomodulators are at increased risk of impaired humoral response to SARS-CoV-2 vaccines. We aimed to identify factors associated with breakthrough infection among patients with rheumatic diseases.METHODS:
We identified patients with rheumatic diseases being treated with immunomodulators in a large healthcare system who received at least two doses of either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) vaccines or one dose of the Johnson & Johnson-Janssen (J&J) vaccine. We followed patients until SARS-CoV-2 infection, death, or December 15, 2021, when the Omicron variant became dominant in our region. We estimated the association of baseline characteristics with the risk of breakthrough infection using multivariable Cox regression.RESULTS:
We analyzed 11,468 patients (75% female, mean age 60 years). Compared to antimalarial monotherapy, multiple immunomodulators were associated with higher risk of infection anti-CD20 monoclonal antibodies (aHR 5.20, 95% CI 2.85, 9.48), CTLA-4 Ig (aHR 3.52, 95% CI 1.90, 6.51), mycophenolate (aHR 2.31, 95% CI 1.25, 4.27), IL-6 inhibitors (aHR 2.15, 95% CI 1.09, 4.24), JAK inhibitors (aHR 2.02, 95% CI 1.01, 4.06), and TNF inhibitors (aHR 1.70, 95% CI 1.09, 2.66). mRNA-1273 recipients had a lower risk of breakthrough infection compared to BNT162b2 recipients (aHR 0.66, 95% CI 0.50, 0.86). There was no association of sex, body mass index, smoking status, race, or ethnicity with risk of breakthrough infection.CONCLUSION:
Among patients with rheumatic diseases, multiple immunomodulators were associated with increased risk of breakthrough infection. These results highlight the need for additional mitigation strategies in this vulnerable population.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Topics:
Vaccines
/
Variants
Language:
English
Journal:
Semin Arthritis Rheum
Year:
2022
Document Type:
Article
Affiliation country:
J.semarthrit.2022.152108
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