Association of COVID-19 Vaccinations with Flares of Systemic Rheumatic Disease: A Case-Crossover Study.
Academic Article
Overview
abstract
OBJECTIVES: To determine the association of COVID-19 vaccination with flares of systemic rheumatic disease (SRD). METHODS: Adults with autoimmune or autoinflammatory conditions ("systemic rheumatic disease") in a single-center COVID-19 Rheumatology Registry were invited to enroll in a study of flares. COVID-19 vaccine information from 3/5/21-9/6/22 was obtained from chart review and self-report. Participants self-reported periods of SRD flare and periods without SRD flare. "Hazard periods" were defined as time before self-report of flare, and "control periods" as time before self-report of no flare. The association between flare and COVID-19 vaccination was evaluated during hazard and control periods through univariate conditional logistic regression stratified by participant, using lookback windows of 2, 7 and 14 days. RESULTS: 434 subjects (mean age 59 years [±13], 84.1% female, 81.8% White, 64.5% inflammatory arthritis, 27.0% connective tissue diseases) contributed both hazard and control periods and were included in analysis. A total of 1316 COVID-19 vaccinations were identified (58.5% Pfizer-BioNTech, 39.5% Moderna, 1.4% Johnson & Johnson); 96.1% of participants received ≥1 dose and 93.1% ≥2 doses. There was no association between COVID-19 vaccination and flares in the subsequent 2, 7 or 14 days (OR 1.46 [95% CI, 0.86-2.46], OR 1.09 [95% CI, 0.76-1.55], OR 0.85 [95% CI, 0.64-1.13] respectively). Analyses stratified on sex, age, SRD subtype and vaccine manufacturer similarly showed no association between vaccination and flare. CONCLUSION: COVID-19 vaccination was not associated with flares in this cohort of participants with SRD. These data are reassuring and can inform shared decision-making on COVID-19 immunization.
