Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period—a cross-sequential study based on COVAD surveys
Authors' 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.
Study context
- Population
- Patients with autoimmune rheumatic diseases (AIRDs) after COVID-19 vaccination, global COVAD surveysof 15,165 total responses
- Participants
- 3,453 patients
- Outcome
- Incidence of flares after vaccination: patient-reported (a), increased immunosuppression (b), clinical exacerbations (c), worsening of PROMIS scores (d)
Methodological detailsglobal COVAD surveys, regression models
- Global COVAD surveys
- Regression models
Main finding
As reported in the abstract
Incidence of flares after COVID-19 vaccination, by definitions a-d
Patient-reported flares (a)
11.3%
Increased immunosuppression (b)
14.8%
Clinical exacerbations (c)
9.5%
Worsening of PROMIS scores (d)
26.7%
Further findings
Predictors of flares (regression analysis)
| OR (95% CI) | P value | ||
|---|---|---|---|
| AIDm | 1.4 (1.1–1.7) | P = 0.003 | |
| MHD | 1.7 (1.1–2.6) | P = 0.007 | |
| Moderna vaccine recipient | 1.5 (1.09–2.2) | P = 0.014 | |
| MMF useProtective | 0.5 (0.3–0.8) | P = 0.009 | |
| GC useProtective | 0.6 (0.5–0.8) | P = 0.003 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Overall active disease post-vaccinationvs before vaccination | 1.3 (1.1–1.5) | P < 0.001 | |
| 0.512Odds ratio (log scale) |
Agreement between patient-reported and immunosuppression-defined flares
- Moderate agreement, K
- 0.403 (P = 0.022)
Most commonly reported flare symptoms
- Arthritis
- 61.6%
- Fatigue
- 58.8%
Factors associated with self-reported flares
- Higher comorbidities
- P = 0.013
- Mental health disorders (MHDs)
- P < 0.001
- Autoimmune disease multimorbidity (AIDm)
- P < 0.001
Original publication
Flares in autoimmune rheumatic diseases in the post-COVID-19 vaccination period—a cross-sequential study based on COVAD surveys. Rheumatology (Oxford). Published 24 March 2023. doi:10.
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