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Breakthrough SARS-CoV-2 infection in fully vaccinated patients with systemic lupus erythematosus: results from the COVID-19 Vaccination in Autoimmune Disease (COVAD) study

Palazzo L 1 , Lindblom J 1 , Kihlgren Olsson E 1 , Nikiphorou E 2 , Wincup C 3 , Saha S 4 Show all authors , Shaharir SS 5 , Katchamart W 6 , Akarawatcharangura Goo P 7 , Traboco L 8 , Chen YM 9 , Lilleker JB 10 , Nune A 11 , Pauling JD 12 , Agarwal V 13 , Dzifa D 14 , Toro Gutiérrez CE 15 , Caballero-Uribe CV 16 , Chinoy H 10 , COVAD Study Group , Agarwal V 17 , Gupta L 10 , Parodis I 18

Affiliations 

  • 1 Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
  • 2 Centre for Rheumatic Diseases, King's College London, London, UK
  • 3 Division of Medicine, Department of Rheumatology, Rayne Institute, University College London, London, UK
  • 4 Mymensingh Medical College, Mymensingh, Bangladesh
  • 5 Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
  • 6 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 7 Department of Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
  • 8 Section of Rheumatology, Department of Medicine, St. Luke's Medical Center-Global City, Taguig, Philippines
  • 9 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan, Republic of China
  • 10 Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
  • 11 Southport and Ormskirk Hospital NHS Trust, Southport, UK
  • 12 Bristol Medical School Translational Health Sciences, Health Sciences, Bristol, UK
  • 13 Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
  • 14 Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Korle-Bu, Accra, Ghana
  • 15 Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontificia Universidad Javeriana Cali, Cali, Colombia
  • 16 Department of Medicine, Hospital Universidad del Norte, Barranquilla, Atlantico, Colombia
  • 17 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 18 Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. ioannis.parodis@ki.se
Rheumatol Int, 2024 Oct;44(10):1923-1933.
PMID: 39138675 DOI: 10.1007/s00296-024-05682-6

Abstract

OBJECTIVE: To determine the occurrence of breakthrough COVID-19 infections (BIs) in patients with systemic lupus erythematosus (SLE) compared with patients with other rheumatic autoimmune diseases (rAIDs), patients with non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HCs).

METHODS: The study was based on data from 7035 fully vaccinated respondents to the online COVAD questionnaire with SLE (N = 852), rAIDs (N = 3098), or nrAIDs (N = 414), and HCs (N = 2671). BI was defined as COVID-19 infection occurring in individuals vaccinated with ≥ 2 doses (or 1 dose of J&J) ≥ 14 days after vaccination and not after 6 months since the last vaccine dose. Data were analysed using linear and logistic regression models.

RESULTS: A total of 91/852 (10.7%) SLE patients reported at least one BI. The frequency of BIs in SLE patients was comparable to that among HCs (277/2671; p = 0.847) and patients with nrAID (39/414; p = 0.552) but higher than that among patients with other rAIDs (235/3098; p = 0.005). No demographic factors or treatments were associated with BIs in SLE patients (p ≥ 0.05 for all). Joint pain was more frequent in SLE patients than in HCs (odds ratio [OR]: 3.38; 95% confidence interval [CI]: 1.89-6.04; p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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