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Letter
SARS-CoV-2 infection after vaccination in patients with inflammatory rheumatic and musculoskeletal diseases
  1. Saskia Lawson-Tovey1,2,
  2. Kimme L Hyrich2,3,
  3. Laure Gossec4,5,
  4. Anja Strangfeld6,
  5. Loreto Carmona7,
  6. Bernd Raffeiner8,
  7. Gözde Kübra Yardımcı9,
  8. Ludovic Trefond10,
  9. Nicolas Roux11,
  10. Ana Rodrigues12,13,
  11. Charalampos Papagoras14,
  12. Elsa F Mateus15,16,
  13. Xavier Mariette17,
  14. Pedro M Machado18,19,20
  1. 1 Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
  2. 2 National Institute for Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
  3. 3 Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
  4. 4 Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
  5. 5 Rheumatology Department, Pitié-Salpêtrière Hospital, Sorbonne Université, AP-HP, Paris, France
  6. 6 German Rheumatism Research Center (DRFZ Berlin), Epidemiology Unit, Berlin, Germany
  7. 7 Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
  8. 8 Department of Rheumatology, Central Hospital of Bolzano, Bolzano, Italy
  9. 9 Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
  10. 10 CHU Clermont Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied, Inserm U1071, INRA USC2018, M2iSH, Université Clermont Auvergne, Clermont-Ferrand, France
  11. 11 Service de Rhumatologie, Hôpital Robert Schuman, Metz, France
  12. 12 Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
  13. 13 EpiDoC Unit, CEDOC, CHRC Campus Nova Medical School, Lisboa, Portugal
  14. 14 First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
  15. 15 Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
  16. 16 Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), European League Against Rheumatism, Zurich, Switzerland
  17. 17 Department of Rheumatology, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre, France
  18. 18 Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
  19. 19 National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
  20. 20 Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Pedro M Machado, Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London WC1E 6BT, UK; p.machado{at}ucl.ac.uk

http://dx.doi.org/10.1136/annrheumdis-2021-221217

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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 …

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    Footnotes

    • 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.