Journal Article

Factors associated with disease flare following SARS-CoV-2 vaccination in people with inflammatory rheumatic and musculoskeletal diseases: results from the physician-reported EULAR Coronavirus Vaccine (COVAX) Registry

Brocq, Olivier, Törõcsik, Katalin, Popa, Luciana, Gauzere, Loraine, Raftakis, Ioannis, Verlinden, Séverine, Seror, Raphaele, Lanot, Sylvain, Queyrel, Viviane, Jeandel, Pierre-Yves, Stenova, Emoke, Guyot, Marie-Hélène, Carmona, Loreto, Henry, Julien, Strakova, Eva, Toussirot, Eric, Combe, Bernard, Rednic, Simona, Jacob, Marion, Maillard, Hélène, Lamer, François, Gervais, Elisabeth, Amigues, Isabelle, Cuomo, Giovanna, Richez, Christophe, Meric, Jean-Camille, Brockbank, John, Forestier, Romain, Leurs, Amélie, Coury, Fabienne, Deseyne, Nicolas, Mosca, Marta, Durez, Patrick, Trefond, Ludovic, Goulenok, Tiphaine, Desbarbieux, Renaud, Bulina, Inita, Wendling, Daniel, Farisogullari, Bayram, Torre-Rubio, Natalia de la, Gossec, Laure, Mirabel, Marion, Spielmann, Lionel, Raffeiner, Bernd, Burmester, Gerd R, Coquerelle, Pascal, Hyrich, Kimme L, Roux, Nicolas, Veillard, Eric, Cornalba, Martina, Florent, Amélie, Roux, Fabienne, Froissart, Antoine, Mariette, Xavier, Hachulla, Eric, Hocevar, Alojzija, Dubost, Jean-Jacques, Viadere, Gaëlle, Couderc, Marion, Zenone, Thierry, Lawson-Tovey, Saskia, Zepa, Julija, Odnoga, Jozef, S

2024

Overview

ObjectivesTo investigate the frequency and factors associated with disease flare following vaccination against SARS-CoV-2 in people with inflammatory/autoimmune rheumatic and musculoskeletal diseases (I-RMDs).MethodsData from the European Alliance of Associations for Rheumatology Coronavirus Vaccine physician-reported registry were used. Factors associated with flare in patients with I-RMDs were investigated using multivariable logistic regression adjusted for demographic and clinical factors.ResultsThe study included 7336 patients with I-RMD, with 272 of 7336 (3.7%) experiencing flares and 121 of 7336 (1.6%) experiencing flares requiring starting a new medication or increasing the dosage of an existing medication. Factors independently associated with increased odds of flare were: female sex (OR=1.40, 95% CI=1.05 to 1.87), active disease at the time of vaccination (low disease activity (LDA), OR=1.45, 95% CI=1.08 to 1.94; moderate/high disease activity (M/HDA), OR=1.37, 95% CI=0.97 to 1.95; vs remission), and cessation/reduction of antirheumatic medication before or after vaccination (OR=4.76, 95% CI=3.44 to 6.58); factors associated with decreased odds of flare were: higher age (OR=0.90, 95% CI=0.83 to 0.98), non-Pfizer/AstraZeneca/Moderna vaccines (OR=0.10, 95% CI=0.01 to 0.74; vs Pfizer), and exposure to methotrexate (OR=0.57, 95% CI=0.37 to 0.90), tumour necrosis factor inhibitors (OR=0.55, 95% CI=0.36 to 0.85) or rituximab (OR=0.27, 95% CI=0.11 to 0.66), versus no antirheumatic treatment. In a multivariable model using new medication or dosage increase due to flare as the dependent variable, only the following independent associations were observed: active disease (LDA, OR=1.47, 95% CI=0.94 to 2.29; M/HDA, OR=3.08, 95% CI=1.91 to 4.97; vs remission), cessation/reduction of antirheumatic medication before or after vaccination (OR=2.24, 95% CI=1.33 to 3.78), and exposure to methotrexate (OR=0.48, 95% CI=0.26 to 0.89) or rituximab (OR=0.10, 95% CI=0.01 to 0.77), versus no antirheumatic treatment.ConclusionI-RMD flares following SARS-CoV-2 vaccination were uncommon. Factors associated with flares were identified, namely higher disease activity and cessation/reduction of antirheumatic medications before or after vaccination.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited,BMJ Publishing Group
• Subject: Adult / Aged / Antirheumatic Agents / Antirheumatic Agents - therapeutic use / Arthritis / Autoimmune Diseases / Biochemistry / Connective tissue diseases / Coronaviruses / Covid-19 / COVID-19 - immunology / COVID-19 - prevention & control / COVID-19 Vaccines / Dosage / Drug dosages / Epidemiological Science / Epidemiology / Female / Genetics and Molecular Biology(all) / Humans / Immunology / Immunology and Allergy / Immunotherapy / Life Sciences / Male / Methotrexate / Methotrexate - therapeutic use / Middle Aged / Monoclonal antibodies / Musculoskeletal Diseases / Pandemics / Patients / Registries / Remission / Rheumatic Diseases - drug therapy / Rheumatology / Risk Factors / Rituximab / SARS-CoV-2 - immunology / Severe acute respiratory syndrome coronavirus 2 / Sex Factors / Symptom Flare Up / TNF inhibitors / Tumor necrosis factor-TNF / Vaccination / Vaccines