Prevalence and factors associated with flares following COVID-19 mRNA vaccination in patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: a national cohort study

Advances in Rheumatology

Research

Kee Fong Phang¹  Gim Gee Teng²  Margaret Ma²  Peter Cheung²  Manjari Lahiri²  Amelia Santosa²  Sen Hee Tay²  Anselm Mak²  Siaw Ing Yeo³  Ting Hui Woon³  Yih Jia Poh³  Warren Fong⁴  Andrea Low⁴  Li-Ching Chew⁴  Annie Law⁵  Ying Ying Leung⁵  Melonie Sriranganathan⁶  Teck Choon Tan⁷  Tyng Yu Chuah⁸  Nur Emillia Roslan⁸  Stanley Angkodjojo⁸  Kok Ooi Kong⁹  Chuanhui Xu⁹ 

[1] Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Department of Medicine, Alexandra Hospital, Singapore, Singapore;Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore;Department of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, 169856, Singapore, Singapore;Department of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, 169856, Singapore, Singapore;Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Rheumatology, Duke-NUS Medical School, Singapore, Singapore;Department of Rheumatology and Immunology, Singapore General Hospital, Academia, Level 4, 20 College Road, 169856, Singapore, Singapore;Rheumatology, Duke-NUS Medical School, Singapore, Singapore;Rheumatology, Changi General Hospital, Singapore, Singapore;Rheumatology, Khoo Teck Puat Hospital, Singapore, Singapore;Rheumatology, Sengkang General Hospital, Singapore, Singapore;Rheumatology, Tan Tock Seng Hospital, Singapore, Singapore;

关键词: COVID-19;    Autoimmune inflammatory rheumatic diseases;    mRNA vaccine;    Flares;   

DOI  :  10.1186/s42358-023-00316-0

 received in 2022-12-01, accepted in 2023-07-19,  发布年份 2023

来源: Springer

【 摘 要 】

ObjectiveTo determine prevalence and factors associated with flares post Coronavirus disease 2019 (COVID-19) mRNA vaccination in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA).MethodsA retrospective multi-centre study was conducted (January 2021 to February 2022). Data were collected during index visit, defined as first post-vaccine visit in which the patient had a physician-defined flare, or if at least 3 months had elapsed since first vaccine dose, whichever came first. Factors associated with flares were identified using mixed effects Cox regression and expressed as hazard ratio (HR) and 95% confidence interval (CI).ResultsTotal of 2377 patients were included (1563 RA, 415 PsA and 399 SpA). Among patients with RA, PsA and SpA, 21.3%, 24.1% and 21.8% experienced a flare respectively. Of those who experienced a flare, only 10.2%, 11.0% and 14.9% were severe in patients with RA, PsA and SpA respectively. Patients with low or moderate/high disease were more likely to flare compared to those in remission in patients with RA only (HR: 1.68, 95% CI 1.22–2.31; HR: 2.28, 95% CI 1.50–3.48, respectively). Receiving the Moderna vaccine was associated with a higher HR of flare compared to the Pfizer vaccine in patients with PsA only (HR: 2.21, 95% CI 1.20–4.08). Patients who had two vaccine doses were found to be less likely to flare (HR: 0.08, 95% CI 0.06–0.10). HRs of flares were not significantly different among RA, PsA and SpA.ConclusionAbout one-fifth of patients experienced a disease flare post COVID-19 mRNA vaccination, but most flares were non-severe. Patients with active disease prior to vaccination should be monitored closely for disease flares, especially in patients with RA.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 6