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Better outcomes of COVID-19 in vaccinated compared to unvaccinated patients with systemic rheumatic diseases
  1. Charalampos Papagoras1,
  2. George E Fragoulis2,
  3. Nikoleta Zioga3,
  4. Theodora Simopoulou4,
  5. Kleopatra Deftereou5,
  6. Eleni Kalavri6,
  7. Evangelia Zampeli7,8,
  8. Nafsika Gerolymatou9,
  9. Evangelia Kataxaki10,
  10. Konstantinos Melissaropoulos11,
  11. Stylianos Panopoulos2,
  12. Kalliopi Fragiadaki2,
  13. Gerasimos Evangelatos2,
  14. Vasiliki-Kalliopi Bournia2,
  15. Aikaterini Arida2,
  16. Anastasios Karamanakos2,
  17. Maria Pappa2,
  18. Alexandros Panagiotopoulos12,
  19. Christos Koutsianas12,
  20. Georgia Mparouta13,
  21. Theodoros Dimitroulas5,
  22. Stamatis-Nick Liossis14,
  23. Maria G Tektonidou2,
  24. Evrydiki Kravvariti2,
  25. Nikolaos Kougkas5,
  26. Panagiotis Georgiou11,
  27. Paraskevi Voulgari9,
  28. Antonia Elezoglou6,
  29. Dimitrios P Bogdanos4,
  30. Dimitrios Vassilopoulos12,
  31. Petros P Sfikakis2
  1. 1 First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
  2. 2 Joint Academic Rheumatology Program, 1st Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
  3. 3 First Department of Internal Medicine, Democritus University of Thrace, Komotini, Greece
  4. 4 Clinic of Rheumatology and Clinical Immunology, University Hospital of Larissa, Larissa, Greece
  5. 5 Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
  6. 6 Department of Rheumatology, Asklepieion General Hospital, Voula, Athens, Greece
  7. 7 Institute for Autoimmune Systemic and Neurological Diseases, Athens, Greece
  8. 8 Rheumatology Department, Iaso Hospital, Athens, Greece
  9. 9 Rheumatology Clinic, University of Ioannina School of Medicine, Ioannina, Greece
  10. 10 Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece
  11. 11 Department of Rheumatology, Agios Andreas Hospital, Patras, Greece
  12. 12 Joint Academic Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, Athens, Greece
  13. 13 Private Rheumatology Office, Karditsa, Greece
  14. 14 Department of Internal Medicine, University of Patras Medical School, Patras, Greece
  1. Correspondence to Dr Petros P Sfikakis, Joint Rheumatology Program, 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece; psfikakis{at}


Objective Τo report outcomes of breakthrough COVID-19 in comparison with COVID-19 in unvaccinated patients with systemic rheumatic diseases (SRDs).

Methods Patients with SRD with COVID-19 (vaccinated and unvaccinated) were included by their rheumatologists in a registry operated by the Greek Rheumatology Society in a voluntarily basis. Type, date and doses of SARS-CoV-2 vaccines were recorded, and demographics, type of SRD, concurrent treatment, comorbidities and COVID-19 outcomes (hospitalisation, need for oxygen supplementation and death) were compared between vaccinated and unvaccinated patients.

Results Between 1 March 2020 and 31 August 2021, 195 patients with SRD with COVID-19 were included; 147 unvaccinated and 48 vaccinated with at least one dose of a SARS-CoV-2 vaccine (Pfizer n=38 or AstraZeneca n=10). Among vaccinated patients, 29 developed breakthrough COVID-19 >14 days after the second vaccine dose (fully vaccinated), while 19 between the first and <14 days after the second vaccine dose (partially vaccinated). Despite no differences in demographics, SRD type, treatment or comorbidities between unvaccinated and vaccinated patients, hospitalisation and mortality rates were higher in unvaccinated (29.3% and 4.1%, respectively) compared with partially vaccinated (21% and 0%) or fully vaccinated (10.3% and 0%) patients.

Conclusions Vaccinated patients with SRD with breakthrough COVID-19 have better outcomes compared with unvaccinated counterparts with similar disease/treatment characteristics.

  • COVID-19
  • autoimmune diseases
  • vaccination

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor Josef S Smolen

  • Twitter @FragoulisGeorge, @Dr_C_Koutsianas

  • Contributors Drafting of the manuscript and data analysis: CP, GEF, DV and PPS. Data acquisition and revision of the manuscript: all authors. guarantor: PPS

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.