Breakthrough COVID-19 in people with
Rheumatic Disease

Breakthrough COVID-19 in people with Rheumatic Disease

This study looked at a subset of the GRA registry of 197 people with rheumatic disease who were either partially or fully vaccinated and experienced a breakthrough infection. Of the 197 people, 87 (44%) were fully vaccinated. Fully vaccinated is defined by the US Centers for Disease Control and Prevention as ≥14 days after the second dose in a two-dose vaccine or ≥14 days after a single-dose vaccine. Previous research has shown that antibody levels following vaccination were lower among people with rheumatic disease taking immunosuppressive or immunomodulatory medications compared to healthy controls, particularly for those on B-cell depleting therapy (BCDT), such as Rituximab, or mycophenolate (MMF).

This study primarily focused on the fully vaccinated, and out of these, looked deeper into the details behind 22 fully vaccinated and hospitalized patients. The numbers are small in terms of sample size and the research is descriptive, meaning that it describes a population, situation, or phenomenon. Descriptive research focuses on answering how, what, when and where, rather than why. Consequently, results should be interpreted with caution because any number of factors could have affected the hospitalization outcomes. Further research is required to determine any significant relationship between variables such as the specific rheumatic disease, medications taken, rheumatic disease activity, age, other pre-existing conditions, etc.

In this study, 25% of the fully vaccinated patients with breakthrough infections required hospitalization and 6% died. Among those 22 who were fully vaccinated and hospitalized, 41% had used BCDT at the time of vaccination and 45% were using BCDT at the time of COVID-19 diagnosis. Of the 6 patients who died, 60% were taking BCDT at vaccination and 80% at COVID-19 diagnosis. Although only 37% of hospitalized patients were taking glucocorticoids, of the patients who died, 80% were taking glucocorticoids (although mostly in combination with other medications) both at the time of vaccination and at the time of COVID-19 diagnosis. 14% of patients were taking MMF, both at the time of vaccination and at the time of COVID-19 diagnosis, but none of the patients who died were taking MMF. Reassuringly, breakthrough infections leading to hospitalization were infrequent among those using other immunomodulators, supporting findings from multiple registries.

197 people partially or fully vaccinated against SARS-CoV-2, who developed COVID-19 between January 5 – September 30, 2021, were identified in the Global Rheumatology Alliance Registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series. The 87 fully vaccinated individuals were 77% female with a mean age of 54 years, 56% were Caucasian, and 75% were from North America. The most common rheumatic diseases in these fully vaccinated people were rheumatoid arthritis (39%), psoriatic arthritis (14%), and systemic lupus erythematosus (12%). At the time of infection, 34% were taking only conventional synthetic disease modifying antirheumatic drugs, 28% only biologic/targeted synthetic disease modifying antirheumatic drugs, and 31% were on both types. Among the 37% taking glucocorticoids, 21% were taking prednisone of which 7% were on ≥10mg/day. Additionally, 21% of patients had moderate or high rheumatic disease activity at the time of COVID-19 diagnosis. Characteristics for the 22 hospitalized patients are shown in the appended table.

This research presents the largest series of breakthrough COVID-19 among people with rheumatic disease to date. The data supports prior findings of reduced vaccine effectiveness based on the use of certain classes of antirheumatic medication. Limitations of the research include potential selection bias because the people who were entered into the study might have been at highest risk for poor vaccine responses, and therefore breakthrough infections. Also, there were no specific measures of vaccine effectiveness with antibody levels or other tests. Results do indicate that people with rheumatic disease should be prioritized for additional vaccination doses, for other risk mitigation measures, and for the use of strategies (including pre-exposure monoclonal antibodies and antivirals) that compensate for a reduced or absent immune response to vaccination.

Study Title

SARS-CoV-2 Breakthrough Infections Among Vaccinated Individuals with Rheumatic Disease: Results From the COVID-19 Global Rheumatology Alliance Provider Registry

Link to original paper: SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry | RMD Open (bmj.com) 

Date original paper published: April 06, 2022. 

Authors of original paper

Jean W Liew, Milena A Gianfrancesco, Jinoos Yazdany, et al.

Lay summary contributors

Nadine Lalonde, Maxwell Howard, and John Wallace

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The table is wider than the layout of the website theme.  The screwed up table is below, within the theme constraints.

I have embedded the table as a PDF into this page.  In the embed widget on the top right hand corner you can do lots of things including seeing it full page, print and download etc.

Alternatively, Click here and it can also be displayed this way.  which takes out the navigation stuff that normally shows up on the right hand side of the page.

Decisions, Decisions.

This raised a point in my mind.  Should we embed pdfs of all the PLS pages so people can download and print them in the original format?

Details of Fully Vaccinated and Hospitalized Individuals Reported to the C19-GRA Registry (N=22)

* Highest level of hospital treatment; if no discharge status, they were alive at discharge

Abbreviations: RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; BCDT, B-cell depleting therapy