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. 2023 Dec 1;62(12):3838-3848.
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

Kshitij Jagtap  1 , R Naveen  2 , Jessica Day  3   4   5 , Parikshit Sen  6 , Binit Vaidya  7 , Arvind Nune  8 , Elena Nikiphorou  9   10 , Ai Lyn Tan  11   12 , Vishwesh Agarwal  13 , Sreoshy Saha  14 , Samuel Katsuyuki Shinjo  15 , Nelly Ziade  16   17 , Mrudula Joshi  18 , Tsvetelina Velikova  19 , Marcin Milchert  20 , Ioannis Parodis  21   22 , Abraham Edgar Gracia-Ramos  23 , Lorenzo Cavagna  24 , Masataka Kuwana  25 , Johannes Knitza  26 , Ashima Makol  27 , Aarat Patel  28 , John D Pauling  29   30 , Chris Wincup  31   32 , Bhupen Barman  33 , Erick Adrian Zamora Tehozol  34 , Jorge Rojas Serrano  35 , Ignacio García-De La Torre  36 , Iris J Colunga-Pedraza  37 , Javier Merayo-Chalico  38 , Okwara Celestine Chibuzo  39 , Wanruchada Katchamart  40 , Phonpen Akawatcharangura Goo  41 , Russka Shumnalieva  42 , Yi-Ming Chen  43   44 , Leonardo Santos Hoff  45 , Lina El Kibbi  46 , Hussein Halabi  47 , Syahrul Sazliyana Shaharir  48 , A T M Tanveer Hasan  49 , Dzifa Dey  50 , Carlos Enrique Toro Gutiérrez  51 , Carlo Vinicio Caballero-Uribe  52 , James B Lilleker  53   54 , Babur Salim  55 , Tamer Gheita  56 , Tulika Chatterjee  57 , Miguel A Saavedra  58 , Oliver Distler  59 ; COVAD Study Group; Hector Chinoy  53   60   61 , Vikas Agarwal  2 , Rohit Aggarwal  62 , Latika Gupta  53   63   64
Collaborators, Affiliations

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

Kshitij Jagtap et al. Rheumatology (Oxford). .

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: COVID-19; autoimmunity; flares; rheumatic; vaccination; vaccination hesitancy.

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