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  1. R. Hasseli1,
  2. B. F. Hoyer2,
  3. H. M. Lorenz3,
  4. A. Pfeil4,
  5. A. Regierer5,
  6. J. Richter6,
  7. T. Schmeiser7,
  8. A. Strangfeld5,
  9. A. Krause8,
  10. R. Voll9,
  11. H. Schulze-Koops10,
  12. U. Müller-Ladner1,
  13. C. Specker11
  14. on behalf of COVID-19 task force of the German Society for Rheumatology
  1. 1Campus Kerckhoff, Justus-Liebig-University Giessen, Department of Rheumatology and Clinical Immunology, Giessen, Germany
  2. 2Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Department of Rheumatology and Clinical Immunology, Kiel, Germany
  3. 3University Hospital Heidelberg, Division of Rheumatology, Department of Medicine V, Heidelberg, Germany
  4. 4University Hospital Jena, Department of Internal Medicine III, Jena, Germany
  5. 5German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
  6. 6Heinrich-Heine-University Duesseldorf, Department of Rheumatology and Hiller Research Unit, Duesseldorf, Germany
  7. 7Private Practice, Rheumatology, Cologne, Germany
  8. 8Immanuel Hospital, Department of Rheumatology and Clinical Immunology, Berlin, Germany
  9. 9University Medical Center, Albert-Ludwigs University of Freiburg, Department of Rheumatology and Clinical Immunology, Freiburg, Germany
  10. 10University of Munich, Department of Internal Medicine IV, Division of Rheumatology and Clinical Immunology, Munich, Germany
  11. 11Kliniken Essen-Mitte, Department of Rheumatology and Clinical Immunology, Essen, Germany


Background SARS-CoV-2 vaccines offer the most effective way to reduce the risk of severe COVID-19. Recent data indicate sufficient immune response after vaccination in most patients with inflammatory rheumatic diseases (IRD) on immunomodulatory treatments.

Objectives To investigate the clinical profile of SARS-CoV-2 breakthrough infections among double and triple vaccinated patients with IRD.

Methods Data from the German COVID-19-IRD registry, collected by treating rheumatologists between February 2021 and January 2022 were analysed. Patients double or triple vaccinated against COVID-19 ≥14 days prior to proven SARS-CoV-2 infection were identified, and type of IRD, vaccine, immunomodulation, comorbidities and outcome of the infection were compared with 737 unvaccinated IRD-patients with COVID-19.

Results In total, 271 cases of breakthrough infections were reported, 250 patients (91%) had received two doses of vaccines, 21 (9%) patients three. More than 70% of the patients received Pfizer/Biontech vaccine for the first, second and third vaccination. The median time from second/third vaccine dose to infection was 148 days (range 14-302) days. Most of the patients were diagnosed with inflammatory joint diseases (Table 1). Most of the patients were treated with methotrexate (Table 1). The use of Januskinase inhibitors(i) was more frequently reported in double vaccinated patients (10.4% vs 4.8%), whereas tumor necrosis (TNF)i were reported more often in triple vaccinated patients (33.3% vs. 22.8). Hospitalisation rate was higher in unvaccinated IRD-patients than in vaccinated ones, while fatality rate was similar in unvaccinated and double vaccinated patients. Although the rate of comorbidities and median age were higher in triple-vaccinated patients, infected patients showed a lower rate of hospitalisation, neither COVID-19 related complications, nor the need of oxygen treatment or death.

Table 1.

Profile of vaccinated IRD patients

Conclusion In this cohort of triple-vaccinated IRD patients no fatal courses and no COVID-19 related complications were reported, although median age and rate of comorbidities were higher compared to double-vaccinated and unvaccinated patients. These results support the general recommendations to reduce the risk of severe COVID-19 disease by administering three doses of vaccine, especially in patients with older age, presence of comorbidities, and on immunomodulatory treatment.

Disclosure of Interests None declared

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