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

COVAD Study Group; Kshitij Jagtap; R Naveen; Jessica Day; Parikshit Sen; Binit Vaidya; Arvind Nune; Elena Nikiphorou; Ai Lyn Tan; Vishwesh Agarwal; Sreoshy Saha; Samuel Katsuyuki Shinjo; Nelly Ziade; Mrudula Joshi; Tsvetelina Velikova; Marcin Milchert; Ioannis Parodis; Abraham Edgar Gracia-Ramos; Lorenzo Cavagna; Masataka Kuwana; Johannes Knitza; Ashima Makol; Aarat Patel; John D Pauling; Chris Wincup; Bhupen Barman; Erick Adrian Zamora Tehozol; Jorge Rojas Serrano; Ignacio García-De La Torre; Iris J Colunga-Pedraza; Javier Merayo-Chalico; Latika Gupta; et al

doi:10.1093/rheumatology/kead144

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

COVAD Study Group , Kshitij Jagtap, R Naveen, Jessica Day, Parikshit Sen, Binit Vaidya, Arvind Nune, Elena Nikiphorou, Ai Lyn Tan, Vishwesh Agarwal, Sreoshy Saha, Samuel Katsuyuki Shinjo, Nelly Ziade, Mrudula Joshi, Tsvetelina Velikova, Marcin Milchert, Ioannis Parodis, Abraham Edgar Gracia-Ramos, Lorenzo Cavagna, Masataka KuwanaJohannes Knitza, Ashima Makol, Aarat Patel, John D Pauling, Chris Wincup, Bhupen Barman, Erick Adrian Zamora Tehozol, Jorge Rojas Serrano, Ignacio García-De La Torre, Iris J Colunga-Pedraza, Javier Merayo-Chalico, Latika Gupta^*, et al

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

17 Citations (Scopus)

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.

Original language	English
Pages (from-to)	3838-3848
Number of pages	11
Journal	Rheumatology
Volume	62
Issue number	12
Early online date	24 Mar 2023
DOIs	https://doi.org/10.1093/rheumatology/kead144
Publication status	Published - 1 Dec 2023

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Humans
COVID-19 Vaccines
COVID-19/epidemiology
Vaccination
Autoimmune Diseases/epidemiology
Rheumatic Diseases/epidemiology

Access to Document

10.1093/rheumatology/kead144

Handle.net

Persistent link

Cite this

COVAD Study Group , Jagtap, K., Naveen, R., Day, J., Sen, P., Vaidya, B., Nune, A., Nikiphorou, E., Tan, A. L., Agarwal, V., Saha, S., Shinjo, S. K., Ziade, N., Joshi, M., Velikova, T., Milchert, M., Parodis, I., Edgar Gracia-Ramos, A., Cavagna, L., ... al, E. (2023). Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period: a cross-sequential study based on COVAD surveys. Rheumatology, 62(12), 3838-3848. https://doi.org/10.1093/rheumatology/kead144

@article{56e3c9494c0e47e4a1ddd232aee63fca,

title = "Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period: a cross-sequential study based on COVAD surveys",

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.",

keywords = "Humans, COVID-19 Vaccines, COVID-19/epidemiology, Vaccination, Autoimmune Diseases/epidemiology, Rheumatic Diseases/epidemiology",

author = "\{COVAD Study Group\} and Kshitij Jagtap and R Naveen and Jessica Day and Parikshit Sen and Binit Vaidya and Arvind Nune and Elena Nikiphorou and Tan, \{Ai Lyn\} and Vishwesh Agarwal and Sreoshy Saha and Shinjo, \{Samuel Katsuyuki\} and Nelly Ziade and Mrudula Joshi and Tsvetelina Velikova and Marcin Milchert and Ioannis Parodis and \{Edgar Gracia-Ramos\}, Abraham and Lorenzo Cavagna and Masataka Kuwana and Johannes Knitza and Ashima Makol and Aarat Patel and Pauling, \{John D\} and Chris Wincup and Bhupen Barman and \{Zamora Tehozol\}, \{Erick Adrian\} and \{Rojas Serrano\}, Jorge and \{Garc{\'i}a-De La Torre\}, Ignacio and Colunga-Pedraza, \{Iris J\} and Javier Merayo-Chalico and Latika Gupta and et al",

year = "2023",

month = dec,

day = "1",

doi = "10.1093/rheumatology/kead144",

language = "English",

volume = "62",

pages = "3838--3848",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "12",

}

COVAD Study Group , Jagtap, K, Naveen, R, Day, J, Sen, P, Vaidya, B, Nune, A, Nikiphorou, E, Tan, AL, Agarwal, V, Saha, S, Shinjo, SK, Ziade, N, Joshi, M, Velikova, T, Milchert, M, Parodis, I, Edgar Gracia-Ramos, A, Cavagna, L, Kuwana, M, Knitza, J, Makol, A, Patel, A, Pauling, JD, Wincup, C, Barman, B, Zamora Tehozol, EA, Rojas Serrano, J, García-De La Torre, I, Colunga-Pedraza, IJ, Merayo-Chalico, J, Gupta, L & al, E 2023, 'Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period: a cross-sequential study based on COVAD surveys', Rheumatology, vol. 62, no. 12, pp. 3838-3848. https://doi.org/10.1093/rheumatology/kead144

TY - JOUR

T1 - Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period

T2 - a cross-sequential study based on COVAD surveys

AU - COVAD Study Group

AU - Jagtap, Kshitij

AU - Naveen, R

AU - Day, Jessica

AU - Sen, Parikshit

AU - Vaidya, Binit

AU - Nune, Arvind

AU - Nikiphorou, Elena

AU - Tan, Ai Lyn

AU - Agarwal, Vishwesh

AU - Saha, Sreoshy

AU - Shinjo, Samuel Katsuyuki

AU - Ziade, Nelly

AU - Joshi, Mrudula

AU - Velikova, Tsvetelina

AU - Milchert, Marcin

AU - Parodis, Ioannis

AU - Edgar Gracia-Ramos, Abraham

AU - Cavagna, Lorenzo

AU - Kuwana, Masataka

AU - Knitza, Johannes

AU - Makol, Ashima

AU - Patel, Aarat

AU - Pauling, John D

AU - Wincup, Chris

AU - Barman, Bhupen

AU - Zamora Tehozol, Erick Adrian

AU - Rojas Serrano, Jorge

AU - García-De La Torre, Ignacio

AU - Colunga-Pedraza, Iris J

AU - Merayo-Chalico, Javier

AU - Gupta, Latika

AU - al, et

PY - 2023/12/1

Y1 - 2023/12/1

N2 - 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.

AB - 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.

KW - Humans

KW - COVID-19 Vaccines

KW - COVID-19/epidemiology

KW - Vaccination

KW - Autoimmune Diseases/epidemiology

KW - Rheumatic Diseases/epidemiology

U2 - 10.1093/rheumatology/kead144

DO - 10.1093/rheumatology/kead144

M3 - Article (Academic Journal)

C2 - 36961331

SN - 1462-0324

VL - 62

SP - 3838

EP - 3848

JO - Rheumatology

JF - Rheumatology

IS - 12

ER -

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

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

Handle.net

Fingerprint

Cite this