Study Supports Recommendation for Triple COVID-19 Vaccination in Patients With Rheumatic Diseases

Patients with inflammatory rheumatic diseases who were at least double-vaccinated against COVID-19 had a reduction in hospitalization due to infection.

Patients with inflammatory rheumatic diseases (IRDs) who are double- or triple-vaccinated against COVID-19 are less likely to be hospitalized due to infection than those who remain unvaccinated, according to study results published in RMD Open.

While the safety profile of COVID-19 vaccines has proven to be similar among patients with and without IRDs, SARS-CoV-2 infections following full vaccination have occurred in both groups.

Using a cohort of patients from the German COVID-19-IRD registry, researchers aimed to assess the frequency and disease course of SARS-CoV-2 infections in the unvaccinated vs vaccinated population.

Data from February 2021 to July 2022 were included in the study. Patients with established IRDs who received positive polymerase chain reaction (PCR) swabs were registered by their treating physician and entered into the database.

Univariate regression analysis was used to assess the relationship between vaccination status and COVID-19-related hospitalization and death.

[O]ur findings support the general recommendation to administer a third dose of SARS CoV-2 vaccines in patients with IRD.

In total, 2314 cases of SARS-CoV-2 infection were included in the analysis (unvaccinated, n=923; double-vaccinated, n=551; triple-vaccinated, n=803; quadruple-vaccinated, n=37). The majority of patients were women and more than 50% had been diagnosed with inflammatory joint diseases. The majority of patients reported no or low IRD activity at the time of infection.  

Hospitalization for COVID-19 was lowest among the triple-vaccinated group (2.7%) and increased in correlation with fewer number of vaccinations received (double-vaccinated group, 8.0%; unvaccinated group, 15.4%). A similar trend was observed in frequency of COVID-19-related complications, with 6.2% of the unvaccinated group reporting complications vs 4.2% and 0.7% of the double- and triple-vaccinated groups, respectively.

Univariate and multivariate logistic regressions confirmed both double- (odds ratio [OR], 0.43; 95% CI, 0.29-0.62) and triple-vaccinated (OR, 0.13; 95% CI, 0.08-0.21) vs unvaccinated status was associated with lower risk for hospitalization. Triple-vaccinated status was also associated with a lower risk for COVID-19-related death (OR, 0.26; 95% CI, 0.09-0.71). COVID-19-related mortality was approximately 2% in the unvaccinated population.

The study was limited by possible reporting bias; the use of cross-sectional data collection; potential unmeasured confounding, and a lack of data on IRD duration; prior medication use; and type of SARS-CoV-2 virus mutation.

Study authors concluded, “Taken together, our findings support the general recommendation to administer a third dose of SARS CoV-2 vaccines in patients with IRD.”


Hasseli R, Richter JG, Hoyer BF, et al; COVID-19 task force of the German Society of Rheumatology collaborators. Characteristics and outcomes of SARS-CoV-2 breakthrough infections among double-vaccinated and triple-vaccinated patients with inflammatory rheumatic diseases. RMD Open. Published online April 17, 2023. doi:10.1136/rmdopen-2023-002998