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Patients with inflammatory rheumatic and musculoskeletal diseases (iRMDs) are often treated with immunomodulatory or immunosuppressive medications; consequently, they have been excluded alongside other immunocompromised patients from late stages of SARS-CoV-2 vaccine trials. SARS-CoV-2 vaccine efficacy in this population is unclear, though initial data are reassuring overall.
However, a slightly lower SARS-CoV-2 immunogenicity of vaccines has been documented in some patients with iRMD.1 2 Some common rheumatic and musculoskeletal disease (RMD) medications have been highlighted as possible influential factors on immunogenicity, particularly rituximab (RTX), mycophenolate mofetil (MMF), methotrexate (MTX), abatacept and glucocorticoids.3–7
The European Alliance of Associations for Rheumatology (EULAR) launched a COVID-19 registry in March 2020, capturing COVID-19 outcomes in the European RMD population. Questions on reinfection and vaccination were added in January 2021. A further EULAR registry (COVAX) was launched in February 2021 to collect data on COVID-19 vaccination and related adverse events among patients with RMD. Here we describe a series of patients who contracted SARS-CoV-2 infection after COVID-19 vaccination between 19 January 2021 and 27 July 2021.
The series consists of 38 adults with iRMDs, 8 from the COVID-19 registry (<1%, out of 9118 patients with iRMD diagnosed with COVID-19) and 30 from the COVAX registry (<1%, out of 4393). Cases were deemed eligible if they were ‘partially vaccinated’ (≥14 days after dose 1 to <14 days after dose 2) or ‘fully vaccinated’ (≥14 days after dose 2/single dose), as per Centers for Disease Control and Prevention definitions8 (17 cases were excluded for this reason). A quarter (26%) were fully vaccinated and 28 cases (74%) were partially vaccinated.
As shown in table 1, 76% of the series is female, with a median age of 58 (IQR 49–65) from 12 countries. The most frequent iRMD …
Handling editor Josef S Smolen
Twitter @saskiaamber, @carmona_loreto, @pedrommcmachado
Contributors SL-T analysed the data. SL-T and PMM drafted the first version of the manuscript. All authors revised the manuscript and approved the final version.
Funding Financial support from the European Alliance of Associations for Rheumatology.
Disclaimer The views expressed here are those of the authors and do not necessarily represent the views of the European League Against Rheumatism, the UK National Health Service or the UK Department of Health, or any other organisation.
Competing interests KLH reports she has received non-personal speaker’s fees from Abbvie and grant income from BMS, UCB, and Pfizer, all unrelated to this manuscript; KLH is supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre. LG reports personal consultant fees from AbbVie, Amgen, BMS, Biogen, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis and UCB, and grants from Amgen, Lilly, Janssen, Pfizer, Sandoz, Sanofi and Galapagos, all unrelated to this manuscript. AS reports research grants from a consortium of 14 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Gilead/Galapagos, Lilly, Mylan/Viatris, Hexal, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi-Aventis and UCB) supporting the German RABBIT register and personal fees from lectures for AbbVie, Celltrion, MSD, Roche, BMS and Pfizer, all outside the submitted work. LC has not received fees or personal grants from any laboratory, but her institute works by contract for laboratories among other institutions, such as Abbvie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, S.A., Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH and UCB Pharma. AR reports research grants and consultant fees from Amgen and Pfizer, all unrelated to this manuscript. CP has received research grants from Pharmaserve-Lilly, Faran and Demo, and speaking and consultant fees from Abbvie, Novartis, Genesis, Aenosasis, GSK and Pfizer, all unrelated to this manuscript. EFM reports that LPCDR received support for specific activities: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern and GAfPA; grants and non-financial support from Pfizer; non-financial support from Grünenthal GmbH, outside the submitted work. XM reports personal consultant fees from BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis and UCB, and grants from Ose Pharmaceutical and Pfizer, all unrelated to this manuscript. PMM has received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this manuscript, and is supported by the NIHR University College London Hospitals Biomedical Research Centre.
Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.