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
Authors' conclusion
I-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.
Study context
- Population
- Patients with inflammatory/autoimmune rheumatic and musculoskeletal diseases (I-RMDs) vaccinated against SARS-CoV-2, EULAR COVAX physician-reported registry
- Participants
- 7,336 patients
- Outcome
- Frequency of and factors associated with disease flare following SARS-CoV-2 vaccination
Methodological detailsphysician-reported registry, multivariable logistic regression adjusted for demographic and clinical factors
- Physician-reported registry
- Multivariable logistic regression adjusted for demographic and clinical factors
Main finding
As reported in the abstract
Disease flare following SARS-CoV-2 vaccination
- Flares
- 272 of 7336 (3.7%)
- Female sex (increased odds of flare), OR
- 1.40, 95% CI=1.05 to 1.87
- Low disease activity (LDA) at vaccination vs remission, OR
- 1.45, 95% CI=1.08 to 1.94
- M/HDA at vaccination vs remission, OR
- 1.37, 95% CI=0.97 to 1.95
- Cessation/reduction of antirheumatic medication before or after vaccination, OR
- 4.76, 95% CI=3.44 to 6.58
- Higher age (decreased odds of flare), OR
- 0.90, 95% CI=0.83 to 0.98
- Non-Pfizer/AstraZeneca/Moderna vaccines vs Pfizer, OR
- 0.10, 95% CI=0.01 to 0.74
- MTX vs no antirheumatic treatment, OR
- 0.57, 95% CI=0.37 to 0.90
- TNFi vs no antirheumatic treatment, OR
- 0.55, 95% CI=0.36 to 0.85
- RTX vs no antirheumatic treatment, OR
- 0.27, 95% CI=0.11 to 0.66
Observational data: associations, not effects.
Further findings
- Flares requiring new medication or dosage increase
- 121 of 7336 (1.6%)
- LDA vs remission, OR
- 1.47, 95% CI=0.94 to 2.29
- M/HDA vs remission, OR
- 3.08, 95% CI=1.91 to 4.97
- Cessation/reduction of antirheumatic medication before or after vaccination, OR
- 2.24, 95% CI=1.33 to 3.78
- MTX vs no antirheumatic treatment, OR
- 0.48, 95% CI=0.26 to 0.89
- RTX vs no antirheumatic treatment, OR
- 0.10, 95% CI=0.01 to 0.77
- Multivariable model
Original publication
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. Ann Rheum Dis. Published 21 October 2024. doi:10.
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