Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period—a cross-sequential study based on COVAD surveys-Reference-Cited by-同舟云学术

Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period—a cross-sequential study based on COVAD surveys

Published:2023-03-24 Issue:12 Volume:62 Page:3838-3848
ISSN:1462-0324
Container-title:Rheumatology
language:en
Short-container-title:

Author:

Jagtap Kshitij¹^ORCID,Naveen R²^ORCID,Day Jessica³⁴⁵^ORCID,Sen Parikshit⁶^ORCID,Vaidya Binit⁷^ORCID,Nune Arvind⁸^ORCID,Nikiphorou Elena⁹¹⁰^ORCID,Tan Ai Lyn¹¹¹²^ORCID,Agarwal Vishwesh¹³^ORCID,Saha Sreoshy¹⁴^ORCID,Shinjo Samuel Katsuyuki¹⁵^ORCID,Ziade Nelly¹⁶¹⁷^ORCID,Joshi Mrudula¹⁸^ORCID,Velikova Tsvetelina¹⁹^ORCID,Milchert Marcin²⁰^ORCID,Parodis Ioannis²¹²²^ORCID,Edgar Gracia-Ramos Abraham²³^ORCID,Cavagna Lorenzo²⁴^ORCID,Kuwana Masataka²⁵^ORCID,Knitza Johannes²⁶^ORCID,Makol Ashima²⁷^ORCID,Patel Aarat²⁸,Pauling John D²⁹³⁰^ORCID,Wincup Chris³¹³²^ORCID,Barman Bhupen³³^ORCID,Zamora Tehozol Erick Adrian³⁴^ORCID,Rojas Serrano Jorge³⁵^ORCID,García-De La Torre Ignacio³⁶^ORCID,Colunga-Pedraza Iris J³⁷^ORCID,Merayo-Chalico Javier³⁸^ORCID,Chibuzo Okwara Celestine³⁹^ORCID,Katchamart Wanruchada⁴⁰^ORCID,Goo Phonpen Akawatcharangura⁴¹,Shumnalieva Russka⁴²^ORCID,Chen Yi-Ming⁴³⁴⁴^ORCID,Hoff Leonardo Santos⁴⁵^ORCID,El Kibbi Lina⁴⁶^ORCID,Halabi Hussein⁴⁷^ORCID,Sazliyana Shaharir Syahrul⁴⁸^ORCID,Hasan A T M Tanveer⁴⁹^ORCID,Dey Dzifa⁵⁰^ORCID,Gutiérrez Carlos Enrique Toro⁵¹^ORCID,Caballero-Uribe Carlo Vinicio⁵²^ORCID,Lilleker James B⁵³⁵⁴^ORCID,Salim Babur⁵⁵^ORCID,Gheita Tamer⁵⁶^ORCID,Chatterjee Tulika⁵⁷^ORCID,Saavedra Miguel A⁵⁸^ORCID,Distler Oliver⁵⁹^ORCID,Griger Zoltán,Kardes Sinan,Andreoli Laura,Lini Daniele,Schreiber Karen,Vince Melinda Nagy,Singh Yogesh Preet,Ranjan Rajiv,Jain Avinash,Pandya Sapan C,Pilania Rakesh Kumar,Sharma Aman,Manesh Manoj M,Gupta Vikas,Kavadichanda Chengappa G,Patro Pradeepta Sekhar,Ajmani Sajal,Phatak Sanat,Goswami Rudra Prosad,Chowdhury Abhra Chandra,Mathew Ashish Jacob,Shenoy Padnamabha,Asranna Ajay,Bommakanti Keerthi Talari,Shukla Anuj,Pande Arunkumar R,Chandwar Kunal,Ghodke Akanksha,Boro Hiya,Fazal Zoha Zahid,Cansu Döndü Üsküdar,Yıldırım Reşit,Gasparyan Armen Yuri,Del Papa Nicoletta,Sambataro Gianluca,Fabiola Atzeni,Govoni Marcello,Parisi Simone,Bocci Elena Bartoloni,Sebastiani Gian Domenico,Fusaro Enrico,Sebastiani Marco,Quartuccio Luca,Franceschini Franco,Sainaghi Pier Paolo,Orsolini Giovanni,De Angelis Rossella,Danielli Maria Giovanna,Venerito Vincenzo,Grignaschi Silvia,Giollo Alessandro,Alluno Alessia,Ioannone Florenzo,Fornaro Marco,Traboco Lisa S,Wibowo Suryo Anggoro Kusumo,Loarce-Martos Jesús,Prieto-González Sergio,Gonzalez Raquel Aranega,Yoshida Akira,Nakashima Ran,Sato Shinji,Kimura Naoki,Kaneko Yuko,Gono Takahisa,Tomaras Stylianos,Proft Fabian Nikolai,Holzer Marie-Therese,Gromova Margarita Aleksandrovna,Aharonov Or,Griger Zoltán,Hmamouchi Ihsane,El Bouchti Imane,Baba Zineb,Giannini Margherita,Maurier François,Campagne Julien,Meyer Alain,Langguth Daman,Limaye Vidya,Needham Merrilee,Srivastav Nilesh,Hudson Marie,Landon-Cardinal Océane,Zuleta Wilmer Gerardo Rojas,Arbeláez Álvaro,Cajas Javier,Silva José António Pereira,Fonseca João Eurico,Zimba Olena,Bohdana Doskaliuk,Ima-Edomwonyi Uyi,Dedeke Ibukunoluwa,Airenakho Emorinken,Madu Nwankwo Henry,Yerima Abubakar,Olaosebikan Hakeem,Becky A,Koussougbo Oruma Devi,Palalane Elisa,So Ho,Ugarte-Gil Manuel Francisco,Chinchay Lyn,Bernaola José Proaño,Pimentel Victorio,Fathi Hanan Mohammed,Mohammed Reem Hamdy A,Harifi Ghita,Fuentes-Silva Yurilís,Cabriza Karoll,Losanto Jonathan,Colaman Nelly,Cachafeiro-Vilar Antonio,Bautista Generoso Guerra,Ho Enrique Julio Giraldo,Nunez Lilith Stange,Cristian Vergara M,Báez Jossiell Then,Alonzo Hugo,Pastelin Carlos Benito Santiago,Salinas Rodrigo García,Obiols Alejandro Quiñónez,Chávez Nilmo,Ordóñez Andrea Bran,Argueta Sandra,Llerena Gil Alberto Reyes,Sierra-Zorita Radames,Arrieta Dina,Hidalgo Eduardo Romero,Saenz Ricardo,Idania Escalante M,Calapaqui Wendy,Quezada Ivonne,Arredondo Gabriela,Chinoy Hector⁵³⁶⁰⁶¹^ORCID,Agarwal Vikas²^ORCID,Aggarwal Rohit⁶²^ORCID,Gupta Latika⁵³⁶³⁶⁴^ORCID,

Affiliation:

1. Seth Gordhandas Sunderdas Medical College and King Edwards Memorial Hospital , Mumbai, Maharashtra, India

2. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India

3. Walter and Eliza Hall Institute of Medical Research , Parkville, VIC, Australia

4. Department of Medical Biology, University of Melbourne , Parkville, VIC, Australia

5. Department of Rheumatology, Royal Melbourne Hospital , Parkville, VIC, Australia

6. Maulana Azad Medical College , New Delhi, Delhi, India

7. National Center for Rheumatic Diseases (NCRD) , Ratopul, Kathmandu, Nepal

8. Southport and Ormskirk Hospital NHS Trust , Southport, UK

9. Centre for Rheumatic Diseases, King’s College London , London, UK

10. Rheumatology Department, King’s College Hospital , London, UK

11. NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust , Leeds, UK

12. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds, UK

13. Mahatma Gandhi Mission Medical College , Navi Mumbai, Maharashtra, India

14. Mymensingh Medical College , Mymensingh, Bangladesh

15. Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo , Sao Paulo, SP, Brazil

16. Rheumatology Department, Saint-Joseph University , Beirut, Lebanon

17. Rheumatology Department, Hotel-Dieu de France Hospital , Beirut, Lebanon

18. Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals , Pune, India

19. Medical Faculty, Sofia University ‘St. Kliment Ohridski’ , Sofia, Bulgaria

20. Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin , Szczecin, Poland

21. Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital , Stockholm, Sweden

22. Department of Rheumatology, Faculty of Medicine and Health, Örebro University , Örebro, Sweden

23. Department of Internal Medicine, General Hospital, National Medical Center, ‘La Raza’, Instituto Mexicano del Seguro Social , Mexico City, Mexico

24. Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia , Pavia, Lombardy, Italy

25. Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine , Tokyo, Japan

26. Medizinische Klinik 3—Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen, Deutschland

27. Division of Rheumatology, Mayo Clinic , Rochester, MN, USA

28. Bon Secours Rheumatology Center and Division of Pediatric Rheumatology, Department of Pediatrics, University of Virginia School of Medicine , Charlottesville, VA, USA

29. Bristol Medical School Translational Health Sciences, University of Bristol , Bristol, UK

30. Department of Rheumatology, North Bristol NHS Trust , Bristol, UK

31. Department of Rheumatology, Division of Medicine, Rayne Institute, University College London , London, UK

32. Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH, GOSH , London, UK

33. Department of General Medicine, All India Institute of Medical Sciences (AIIMS) , Guwahati, India

34. Rheumatology, Medical Care & Research, Centro Medico Pensiones Hospital, Instituto Mexicano del Seguro Social Delegación Yucatán , Yucatán, Mexcio

35. Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias , Mexico City, Mexico

36. Departamento de Inmunología y Reumatología, Hospital General de Occidente and Universidad de Guadalajara , Guadalajara, Jalisco, Mexico

37. Rheumatology, Hospital Universitario Dr Jose Eleuterio Gonzalez , Monterrey, Mexico

38. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City, Mexico

39. Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla/University of Nigeria, Enugu Campus , Enugu, Nigeria

40. Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand

41. Department of Medicine, Queen Savang Vadhana Memorial Hospital , Chonburi, Thailand

42. Department of Rheumatology, Clinic of Rheumatology, University Hospital ‘St. Ivan Rilski’, Medical University, Sofia , Bulgaria

43. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital , Taichung City, Taiwan

44. Department of Medical Research, Taichung Veterans General Hospital , Taichung, Taiwan

45. School of Medicine, Universidade Potiguar (UnP) , Natal, Brazil

46. Rheumatology Unit, Internal Medicine Department, Specialized Medical Center , Riyadh, Saudi Arabia

47. Department of Internal Medicine, Section of Rheumatology, King Faisal Specialist Hospital and Research Center , Jeddah, Saudi Arabia

48. Faculty of Medicine, Universiti Kebangsaan Malaysia , Kuala Lumpur, Malaysia

49. Department of Rheumatology, Enam Medical College & Hospital , Dhaka, Bangladesh

50. Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences , Accra, Ghana

51. Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali , Colombia

52. Department of Medicine, Hospital Universidad del Norte , Barranquilla, Atlantico, Colombia

53. Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester , Manchester, UK

54. Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust , Salford, UK

55. Rheumatology Department, Fauji Foundation Hospital , Rawalpindi, Pakistan

56. Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University , Cairo, Egypt

57. Department of Internal Medicine, University of Illinois College of Medicine at Peoria , Peoria, IL, USA

58. Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS , Mexico City, Mexico

59. Department of Rheumatology, University Hospital Zurich, University of Zurich , Zurich, Switzerland

60. National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester , Manchester, UK

61. Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Salford, UK

62. Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine , Pittsburgh, PA, USA

63. Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust , Wolverhampton, UK

64. City Hospital, Sandwell and West Birmingham Hospitals NHS Trust , Birmingham, UK

Abstract

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.

Funder

National Institution for Health Research Manchester Biomedical Research Centre Funding Scheme

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

Link

https://academic.oup.com/rheumatology/advance-article-pdf/doi/10.1093/rheumatology/kead144/49851632/kead144.pdf

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