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. 2024 Oct;44(10):1923-1933.
doi: 10.1007/s00296-024-05682-6. Epub 2024 Aug 13.

Breakthrough SARS-CoV-2 infection in fully vaccinated patients with systemic lupus erythematosus: results from the COVID-19 Vaccination in Autoimmune Disease (COVAD) study

Leonardo Palazzo  1 , Julius Lindblom  1 , Emelie Kihlgren Olsson  1 , Elena Nikiphorou  2   3 , Chris Wincup  4   5 , Sreoshy Saha  6 , Syahrul Sazliyana Shaharir  7 , Wanruchada Katchamart  8 , Phonpen Akarawatcharangura Goo  9 , Lisa Traboco  10 , Yi-Ming Chen  11   12 , James B Lilleker  13   14 , Arvind Nune  15 , John D Pauling  16   17 , Vishwesh Agarwal  18 , Dey Dzifa  19 , Carlos Enrique Toro Gutiérrez  20 , Carlo V Caballero-Uribe  21 , Hector Chinoy  13   22   23 ; COVAD Study Group; Vikas Agarwal #  24 , Latika Gupta  13   25 , Ioannis Parodis #  26   27
Collaborators, Affiliations

Breakthrough SARS-CoV-2 infection in fully vaccinated patients with systemic lupus erythematosus: results from the COVID-19 Vaccination in Autoimmune Disease (COVAD) study

Leonardo Palazzo et al. Rheumatol Int. 2024 Oct.

Abstract

Objective: To determine the occurrence of breakthrough COVID-19 infections (BIs) in patients with systemic lupus erythematosus (SLE) compared with patients with other rheumatic autoimmune diseases (rAIDs), patients with non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HCs).

Methods: The study was based on data from 7035 fully vaccinated respondents to the online COVAD questionnaire with SLE (N = 852), rAIDs (N = 3098), or nrAIDs (N = 414), and HCs (N = 2671). BI was defined as COVID-19 infection occurring in individuals vaccinated with ≥ 2 doses (or 1 dose of J&J) ≥ 14 days after vaccination and not after 6 months since the last vaccine dose. Data were analysed using linear and logistic regression models.

Results: A total of 91/852 (10.7%) SLE patients reported at least one BI. The frequency of BIs in SLE patients was comparable to that among HCs (277/2671; p = 0.847) and patients with nrAID (39/414; p = 0.552) but higher than that among patients with other rAIDs (235/3098; p = 0.005). No demographic factors or treatments were associated with BIs in SLE patients (p ≥ 0.05 for all). Joint pain was more frequent in SLE patients than in HCs (odds ratio [OR]: 3.38; 95% confidence interval [CI]: 1.89-6.04; p < 0.001) or nrAID patients (OR: 2.44; 95% CI: 1.04-5.75; p = 0.041). Patient with SLE did not report a higher frequency of hospitalisation or need for advanced treatment for COVID-19 infection compared with disease controls and HCs, respectively.

Conclusion: COVID-19 vaccination conferred similar protection against COVID-19 infection in terms of frequency and severity in patients with SLE to that reported by healthy individuals.

Keywords: Autoimmune disease; Breakthrough infection; COVID-19; Rheumatology; Survey; Systemic lupus erythematosus; Vaccination.

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Figures

Fig. 1
Fig. 1
COVID-19 BIs in the study population. Bar plots depicting the proportion of patients with SLE, HC, patients with rAID, and patients with nrAID who reported a BI. BI breakthrough infection; HC healthy controls; nrAID non-rheumatic autoimmune disease; rAID rheumatic autoimmune disease; SLE systemic lupus erythematosus
Fig. 2
Fig. 2
Factors associated with COVID-19 BIs in the SLE population. Forest plot illustrating results for SLE patients reporting a BI and SLE patients not reporting a BI, analysed by univariable logistic regression. BI breakthrough infection; CI confidence interval; OR odds ratio; SLE systemic lupus erythematosus
Fig. 3
Fig. 3
Characteristics of COVID-19 BIs in patients with SLE versus healthy controls. Forest plot illustrating results for SLE patients reporting a BI and HC reporting a BI, analysed by multivariable logistic regression adjusting for age, sex, and ethnicity. BI breakthrough infection; CI confidence interval; HC healthy controls; OR odds ratio; SLE systemic lupus erythematosus
Fig. 4
Fig. 4
Characteristics of COVID-19 BIs in patients with SLE versus patients with rAID. Forest plot illustrating results for SLE patients reporting a BI and rAID patients reporting a BI, analysed by multivariable logistic regression adjusting for age, sex, and ethnicity. BI breakthrough infection; CI confidence interval; OR odds ratio; rAID rheumatic autoimmune disease; SLE systemic lupus erythematosus
Fig. 5
Fig. 5
Characteristics of COVID-19 BIs in patients with SLE versus patients with nrAID. Forest plot illustrating results for SLE patients reporting a BI and nrAID patients reporting a BI, analysed by multivariable logistic regression adjusting for age, sex, and ethnicity. BI breakthrough infection; CI confidence interval; nrAID non-rheumatic autoimmune disease; OR odds ratio; SLE systemic lupus erythematosus
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