Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period-a cross-sequential study based on COVAD surveys
Articolo
Data di Pubblicazione:
2023
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.
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.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
COVID-19; autoimmunity; flares; rheumatic; vaccination; vaccination hesitancy.
Elenco autori:
Jagtap, Kshitij; Naveen, R; Day, Jessica; Sen, Parikshit; Vaidya, Binit; Nune, Arvind; Nikiphorou, Elena; Lyn Tan, Ai; Agarwal, Vishwesh; Saha, Sreoshy; Katsuyuki Shinjo, Samuel; Ziade, Nelly; Joshi, Mrudula; Velikova, Tsvetelina; Milchert, Marcin; Parodis, Ioannis; Edgar Gracia-Ramos, Abraham; Cavagna, Lorenzo; Kuwana, Masataka; Knitza, Johannes; Makol, Ashima; Patel, Aarat; D Pauling, John; Wincup, Chris; Barman, Bhupen; Adrian Zamora Tehozol, Erick; Rojas Serrano, Jorge; García-De La Torre, Ignacio; J Colunga-Pedraza, Iris; Merayo-Chalico, Javier; Celestine Chibuzo, Okwara; Katchamart, Wanruchada; Akawatcharangura Goo, Phonpen; Shumnalieva, Russka; Chen, Yi-Ming; Santos Hoff, Leonardo; El Kibbi, Lina; Halabi, Hussein; Sazliyana Shaharir, Syahrul; M Tanveer Hasan, A T; Dey, Dzifa; Enrique Toro Gutiérrez, Carlos; Vinicio Caballero-Uribe, Carlo; B Lilleker, James; Salim, Babur; Gheita, Tamer; Chatterjee, Tulika; A Saavedra, Miguel; Distler, Oliver; Study Group, Covad; Chinoy, Hector; Agarwal, Vikas; Aggarwal, Rohit; Gupta, Latika; Griger, Zoltán; Kardes, Sinan; Andreoli, Laura; Lini, Daniele; Schreiber, Karen; Nagy Vince, Melinda; Preet Singh, Yogesh; Ranjan, Rajiv; Jain, Avinash; C Pandya, Sapan; Kumar Pilania, Rakesh; Sharma, Aman; M, Manesh Manoj; Gupta, Vikas; G Kavadichanda, Chengappa; Sekhar Patro, Pradeepta; Ajmani, Sajal; Phatak, Sanat; Prosad Goswami, Rudra; Chandra Chowdhury, Abhra; Jacob Mathew, Ashish; Shenoy, Padnamabha; Asranna, Ajay; Talari Bommakanti, Keerthi; Shukla, Anuj; Pande, Arunkumar R.; Chandwar, Kunal; Ghodke, Akanksha; Boro, Hiya; Zahid Fazal, Zoha; Üsküdar Cansu, Döndü; Yıldırım, Reşit; Yuri Gasparyan, Armen; Del Papa, Nicoletta; Sambataro, Gianluca; Fabiola, Atzeni; Govoni, Marcello; Parisi, Simone; Bartoloni Bocci, Elena; Domenico Sebastiani, Gian; Fusaro, Enrico; Sebastiani, Marco; Quartuccio, Luca; Franceschini, Franco; Paolo Sainaghi, Pier; Orsolini, Giovanni; De Angelis, Rossella; Giovanna Danielli, Maria; Venerito, Vincenzo; Grignaschi, Silvia; Giollo, Alessandro; Alluno, Alessia; Ioannone, Florenzo; Fornaro, Marco; S Traboco, Lisa; Anggoro Kusumo Wibowo, Suryo; Loarce-Martos, Jesús; Prieto-González, Sergio; Aranega Gonzalez, Raquel; Yoshida, Akira; Nakashima, Ran; Sato, Shinji; Kimura, Naoki; Kaneko, Yuko; Gono, Takahisa; Tomaras, Stylianos; Nikolai Proft, Fabian; Holzer, Marie-Therese; Aleksandrovna Gromova, Margarita; 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; Gerardo Rojas Zuleta, Wilmer; Arbeláez, Álvaro; Cajas, Javier; António Pereira Silva, José; Eurico Fonseca, João; Zimba, Olena; Bohdana, Doskaliuk; Ima-Edomwonyi, Uyi; Dedeke, Ibukunoluwa; Airenakho, Emorinken; Henry Madu, Nwankwo; Yerima, Abubakar; Olaosebikan, Hakeem; A., Becky; Devi Koussougbo, Oruma; Palalane, Elisa; So, Ho; Francisco Ugarte-Gil, Manuel; Chinchay, Lyn; Proaño Bernaola, José; Pimentel, Victorio; Mohammed Fathi, Hanan; A Mohammed, Reem Hamdy; Harifi, Ghita; Fuentes-Silva, Yurilís; Cabriza, Karoll; Losanto, Jonathan; Colaman, Nelly; Cachafeiro-Vilar, Antonio; Guerra Bautista, Generoso; Julio Giraldo Ho, Enrique; Stange Nunez, Lilith; M, Cristian Vergara; Then Báez, Jossiell; Alonzo, Hugo; Benito Santiago Pastelin, Carlos; García Salinas, Rodrigo; Quiñónez Obiols, Alejandro; Chávez, Nilmo; Bran Ordóñez, Andrea; Argueta, Sandra; Alberto Reyes Llerena, Gil; Sierra-Zorita, Radames; Arrieta, Dina; Romero Hidalgo, Eduardo; Saenz, Ricardo; M, Idania Escalante; Calapaqui, Wendy; Quezada, Ivonne; Arredondo., and Gabriela
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