The clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 were assessed in a study published in Rheumatic and Musculoskeletal Diseases Open.

Patients with rheumatic disease enrolled in the COVID 19-Global Rheumatology Alliance registry were included in the study, all of whom developed breakthrough COVID-19 between January 5 and September 30, 2021.

A breakthrough infection was defined as that occurring at least 14 days after a single dose or after the second of a 2-dose vaccine series. COVID-19 symptoms and outcomes were analyzed along with participants’ clinical and demographic characteristics.


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A total of 197 participants (n=110 partially vaccinated; n=87 fully vaccinated) were included in the study. The mean age of the sample was 53.8±16.3 years; 77% (n=67) were women; and 56.3% (n=49) were White. The most common vaccine received by participants was the messenger RNA (mRNA) vaccine (Pfizer BioNTech, 51.7%; Moderna, 24.1%).

Among those who were fully vaccinated, infection occurred at 112±60 days after the second COVID-19 dose; 26% (n=22) of patients required hospitalization, with relatively few cases of complications related to COVID-19.

Among the 22 patients who were hospitalized after full vaccination, 9 were receiving B-cell depleting therapy (BCDT; n=6 received monotherapy) at the time of vaccination. The majority of participants (64%) were not receiving treatment with systemic glucocorticoids.

Mortality occurred among 5 participants.

Study limitations included potential selection bias, the cross-sectional design, and the inability to assess differences between medication classes, vaccine types, and rheumatic diseases.

The study researchers concluded that there is “reduced vaccine immunogenicity based on the use of certain classes of antirheumatic medications.” They further indicated that individuals “with rheumatic disease [receiving] medications such as BCDT and mycophenolate who required [hospitalization]…should be [prioritized] and strongly recommended for other risk mitigation measures beyond additional doses of vaccine.”

The researchers also noted that these strategies should “compensate for a reduced or absent humoral immune response to vaccination in high-risk individuals with rheumatic diseases” and may include “additional vaccine doses or pre-exposure or postexposure prophylaxis with monoclonal antibodies.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Liew J, Gianfrancesco M, Harrison C, et al. SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry. RMD Open. 2022;8:e002187. doi:10.1136/rmdopen-2021-002187