AB0074 VACCINATION RATE, ADVERSE REACTIONS, AND REASONS FOR NONVACCINATION OF COVID-19 VACCINE UP TO FIFTH DOSE IN PATIENTS WITH RHEUMATOID ARTHRITIS IN A JAPANESE REAL-WORLD CLINICAL PRACTICE
Authors: Y. Hirano, Y. Saito
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The first coronavirus infection was confirmed in Wuhan City, People's Republic of China, in December 2019. On January 30, 2020, the World Health Organization declared the novel coronavirus disease a public health emergency of international concern. On March 11, 2020, World Health Organization announced that the new coronavirus infection can be regarded as a pandemic because of the global spread of the infection. The world's first authorization for a coronavirus disease 2019 vaccine (CV) in the UK was in December 2020. The first authorization for a CV in Japan was in February 2021. A maximum of five times of vaccination had been performed in Japanese people until January 2023. Patients with rheumatoid arthritis (RA) are generally immunocompromised because of the drugs used for RA treatment. Patients with RA are recommended to receive a CV in the 2021 update of the EULAR recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2 [1]. However, some patients with RA rejected CV for various reasons or reports of adverse reactions (ARs) in clinical practice. Real-world clinical information on CV is necessary for better relationships between patients with RA and their physicians. We reported the vaccination rate, ARs, and reasons for nonvaccination of CV in patients with RA up to the third vaccination in EULAR 2023 [2]. This study investigated those up to the fifth vaccination. <h3>Objectives:</h3> This retrospective study aimed to determine the vaccination rate, ARs, and reasons for nonvaccination of CV up to the fifth vaccination in patients with RA in clinical practice. <h3>Methods:</h3> The vaccination rate, ARs, and reasons for nonvaccination of CV in patients with RA on clinical records of our institute were investigated up to the fifth vaccination. Patients were divided into three age groups: 0–64 years old (YG), 65–74 years old (OG), and 75≤ years old (VOG). The association between age groups and vaccination rates was also investigated. The Cochran–Armitage test was used for statistical analysis. <h3>Results:</h3> Regarding patient background (n = 501), the mean age was 66.5 years (YG, n = 190; OG, n = 171; VOG, n = 140; female, 74.3%; mean RA duration, 14.2 years). The vaccination rate among all patients was 6.8% for nonvaccination; 93.2% for the first dose; 93.0%, second dose; 88.4%, third dose; 70.3%, forth dose and 47.9%, fifth dose. A significant decrease over time was observed (p &lt; 0.01). Nonvaccination was observed in 13.0%, 9.2%, and 2.9% of those in YG, OG, and VOG, respectively. A higher rate of nonvaccination was observed in the YG (p &lt; 0.01). The results of the analysis by age group were 88.9%/95.3%/96.4% (1st dose), 88.9%/94.7%/96.4% (2nd dose), 81.1%/91.2%/95.0% (3rd dose), 50.0%/80.1%/85.7% (4th dose), and 25.3%/59.6%/64.3% (5th dose) among the YG/OG/VOG, respectively (Figure 1). A significant decrease over time was observed in all age groups. ARs occurred in 9.2%, 15.0%, 19.4%, 16.5% and 12.9% of the patients receiving the first, second, third, fourth and fifth doses, respectively. Top three of ARs were fever, fatigue, and headache. Among the reasons for nonvaccination, 22 (64.7%) patients were concerned about ARs to CV and 4 (11.8%) thought that CV was unnecessary. <h3>Conclusion:</h3> CV rate in our cohort was higher than that of whole nation in Japan (80.7% for the first dose, 79.8% for the second dose, 67.3% for the third dose). CV rate has been declining steadily in patients with RA, with a stronger trend in younger age groups. In addition to age and patients' perspectives, the change of severity of COVID19 infection from severe disease to milder disease is thought to be influencing the rate of CV. Fear of ARs was the most frequent reason for nonvaccination. <h3>REFERENCES:</h3> [1] Landewé RBM et al. Ann Rheum Dis 2022. [2] Hirano Y et al. Ann Rheum Dis 2023, suppl 1. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>