Epidemiology
CLINICAL SCIENCE Impact of vaccination on postacute sequelae of SARS CoV-2 infection in patients with rheumatic diseases Naomi J Patel, 1 Claire Cook, 1 Kathleen Vanni, 2 Xiaoqing Fu, 1 Xiaosong Wang, 2 Yumeko Kawano , 2 Grace Qian, 2 Buuthien Hang, 1 Shruthi Srivatsan, 1 Emily P Banasiak, 2 Emily Kowalski, 2 Katarina Bade, 2 Yuqing Zhang , 1 Jeffrey A Sparks , 2 Zachary S. Wallace 1
ABSTRACT Objective Vaccination decreases the risk of severe COVID-19 but its impact on postacute sequelae of COVID-19 (PASC) is unclear among patients with systemic autoimmune rheumatic diseases (SARDs) who may have blunted vaccine immunogenicity and be vulnerable to PASC. Methods We prospectively enrolled patients with SARD from a large healthcare system who survived acute infection to complete surveys. The symptom-free duration and the odds of PASC (any symptom lasting ≥28 or 90 days) were evaluated using restricted mean survival time and multivariable logistic regression, respectively, among those with and without breakthrough infection (≥14 days after initial vaccine series). Results Among 280 patients (11% unvaccinated; 48% partially vaccinated; 41% fully vaccinated), the mean age was 53 years, 80% were female and 82% were white. The most common SARDs were inflammatory arthritis (59%) and connective tissue disease (24%). Those with breakthrough infection had more upper respiratory symptoms, and those with non-breakthrough infection had more anosmia, dysgeusia and joint pain. Compared with those with non-breakthrough COVID-19 infection (n=164), those with breakthrough infection (n=116) had significantly more symptom-free days over the follow-up period (+21.4 days, 95% CI 0.95 to 41.91; p=0.04) and lower odds of PASC at 28 and 90 days (adjusted OR, aOR 0.49, 95% CI 0.29 to 0.83 and aOR 0.10, 95% CI 0.04 to 0.22, respectively). Conclusion Vaccinated patients with SARDs were less likely to experience PASC compared with those not fully vaccinated. While we cannot rule out the possibility that findings may be due to intrinsic differences in PASC risk from different SARS-CoV-2 variants, these findings support the benefits of vaccination for patients with SARDs and suggest that the immune response to acute infection is important in the pathogenesis of PASC in patients with SARDs. INTRODUCTION Patients with systemic autoimmune rheumatic diseases (SARDs) are at higher risk of severe acute outcomes of COVID-19 infection, though few studies have investigated the risk of longer- term complications of COVID-19. 1–7 Vaccines are safe and efficacious in reducing risk for severe COVID-19 among patients with SARD, but less
Handling editor Josef S Smolen
is known about how they may impact the risk of postacute sequelae of COVID-19 (PASC). PASC most often refers to either persistent or new-onset symptoms following acute infection and is typically defined by duration of symp- toms, with some definitions requiring symptoms that persist for at least 1 month and others for at least 3 months following acute infection. 8 9 PASC incorporates a heterogeneous set of symptoms that may include impaired executive function, fatigue, dyspnoea, cough, palpitations, myalgias or arthralgias, and/or anosmia, among others. A higher severity of acute COVID-19 is associated with a greater risk of PASC, though asymptomatic patients or those with minimal symptoms can also develop PASC. 1 10 11 Estimates of PASC vary, with population-based studies, suggesting that PASC ⇒ Patient-reported pain and fatigue scores were lower, reflecting less severe pain and fatigue, in those with breakthrough infection compared with those with non-breakthrough infection. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Future studies are needed to determine how additional vaccine doses, early outpatient treatment and immunomodulating medications may affect PASC risk among patients with SARDs. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Postacute sequelae of COVID-19 (PASC) affects many COVID-19 survivors, though the impact of vaccination on the risk and severity of PASC is unclear, especially among those with systemic autoimmune rheumatic diseases (SARDs) who may have impaired responses to vaccines and be particularly vulnerable to PASC. WHAT THIS STUDY ADDS ⇒ In this prospective cohort of patients with SARD, we found that those with vs without breakthrough infection had more symptom-free days over the follow-up period (+21.4 days, 95% CI 0.95 to 41.91; p=0.04) and a lower odds of PASC at 28 days (adjusted OR, aOR 0.49, 95% CI 0.29 to 0.83) and at 90 days (aOR 0.10, 95% CI 0.04 to 0.22).
► Additional supplemental material is published online only. To view, please visit the journal online (http://dx. doi.o rg/10.1 136/ard-2 022- 223439). 1 Rheumatology Unit and Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA 2 Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA Correspondence to Dr Zachary S. Wallace, Clinical Epidemiology Program and Rheumatology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA; z swallace@mgh.h arvard.edu JAS and ZSW are joint senior authors. Received 5 October 2022 Accepted 15 November 2022 Published Online First 28 November 2022
© Author(s) (or their employer(s)) 2023. No
To cite: Patel NJ, Cook C, Vanni K, et al . Ann Rheum Dis 2023; 82 :565–573. commercial re-use. See rights and permissions. Published by BMJ.
Patel NJ, et al . Ann Rheum Dis 2023; 82 :565–573. doi:10.1136/ard-2022-223439
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