Factors associated with disease flare following SARS-CoV-2 vaccination in people with inflammatory rheumatic and musculoskeletal diseases: results from the physician-reported EULAR Coronavirus Vaccine (COVAX) Registry
Authors: Bayram Farisogullari, Saskia Lawson-Tovey, Kimme L Hyrich, Laure Gossec, Loreto Carmona, Anja Strangfeld, Elsa F Mateus, Martin Schäfer, Ana Rodrigues, Eric Hachulla, Jose A Gomez-Puerta, Marta Mosca, Patrick Durez, Ludovic Trefond, Tiphaine Goulenok, Martina Cornalba, Emoke Stenova, Inita Bulina, Eva Strakova, Julija Zepa, Nicolas Roux, Olivier Brocq, Eric Veillard, Bernd Raffeiner, Gerd R Burmester, Xavier Mariette, Pedro M Machado, Viviane Queyrel, Julien Henry, Raphaele Seror, Eric Toussirot, Emoke Stenova, Azeddine Dellal, Vanda Mlynarikova, Romain Forestier, François Lamer, Hélène Maillard, Amélie Leurs, Thierry Zenone, Daniel Wendling, Amélie Florent, Theodoros Dimitroulas, Simona Rednic, Bernard Combe, Yves Piette, Jozef Odnoga, Giovanna Cuomo, Ioannis Raftakis, Jean-Camille Meric, Sylvain Lanot, Marion Mirabel, Mikhail Protopopov, Katalin Törõcsik, John Brockbank, Marion Jacob, Pascal Coquerelle, Christophe Richez, Elisabeth Gervais, Séverine Verlinden, Antoine Froissart, Fabienne Roux, Marion Couderc, Renaud Desbarbieux, Alojzija Hocevar, Pierre-Yves Jeandel, Sophie Rivière, Luciana Popa, Fabienne Coury, Inita Bulina, Jean-Jacques Dubost, Lionel Spielmann, Marie-Hélène Guyot, Nicolas Deseyne, Isabelle Amigues, Dagmar Mičeková, Loraine Gauzere, Gaëlle Viadere, Natalia de la Torre-Rubio, Victor Strotz
Journal: Annals of the Rheumatic Diseases (2024)

To investigate the frequency and factors associated with disease flare following vaccination against SARS-CoV-2 in people with inflammatory/autoimmune rheumatic and musculoskeletal diseases (I-RMDs). Data from the European Alliance of Associations for Rheumatology Coronavirus Vaccine physician-reported registry were used. Factors associated with flare in patients with I-RMDs were investigated using multivariable logistic regression adjusted for demographic and clinical factors. The study included 7336 patients with I-RMD, with 272 of 7336 (3.7%) experiencing flares and 121 of 7336 (1.6%) experiencing flares requiring starting a new medication or increasing the dosage of an existing medication. Factors independently associated with increased odds of flare were: female sex (OR=1.40, 95% CI=1.05 to 1.87), active disease at the time of vaccination (low disease activity (LDA), OR=1.45, 95% CI=1.08 to 1.94; moderate/high disease activity (M/HDA), OR=1.37, 95% CI=0.97 to 1.95; vs remission), and cessation/reduction of antirheumatic medication before or after vaccination (OR=4.76, 95% CI=3.44 to 6.58); factors associated with decreased odds of flare were: higher age (OR=0.90, 95% CI=0.83 to 0.98), non-Pfizer/AstraZeneca/Moderna vaccines (OR=0.10, 95% CI=0.01 to 0.74; vs Pfizer), and exposure to methotrexate (OR=0.57, 95% CI=0.37 to 0.90), tumour necrosis factor inhibitors (OR=0.55, 95% CI=0.36 to 0.85) or rituximab (OR=0.27, 95% CI=0.11 to 0.66), versus no antirheumatic treatment. In a multivariable model using new medication or dosage increase due to flare as the dependent variable, only the following independent associations were observed: active disease (LDA, OR=1.47, 95% CI=0.94 to 2.29; M/HDA, OR=3.08, 95% CI=1.91 to 4.97; vs remission), cessation/reduction of antirheumatic medication before or after vaccination (OR=2.24, 95% CI=1.33 to 3.78), and exposure to methotrexate (OR=0.48, 95% CI=0.26 to 0.89) or rituximab (OR=0.10, 95% CI=0.01 to 0.77), versus no antirheumatic treatment. I-RMD flares following SARS-CoV-2 vaccination were uncommon. Factors associated with flares were identified, namely higher disease activity and cessation/reduction of antirheumatic medications before or after vaccination.