Factors associated with COVID-19 breakthrough infection among vaccinated patients with rheumatic diseases: A cohort study.

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.

• Authors: Naomi J Patel, Xiaosong Wang, Xiaoqing Fu, Yumeko Kawano, Claire Cook, Kathleen M M Vanni, Grace Qian, Emily Banasiak, Emily Kowalski, Yuqing Zhang, Jeffrey A Sparks, Zachary S Wallace
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 58 Pg. 152108 (02 2023) ISSN: 1532-866X [Electronic] United States
• PMID: 36347211 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• 2019-nCoV Vaccine mRNA-1273
• BNT162 Vaccine
• COVID-19 Vaccines

Topics

• Female
• Humans
• Male
• Middle Aged
• 2019-nCoV Vaccine mRNA-1273
• BNT162 Vaccine
• Breakthrough Infections (epidemiology)
• Cohort Studies
• COVID-19 (epidemiology, prevention & control)
• COVID-19 Vaccines
• SARS-CoV-2
• Rheumatic Diseases (epidemiology)