Patients With RA Face Higher Risk of COVID-19, Hospitalization Even When Vaccinated

While being vaccinated against COVID-19 significantly reduces the risk of contracting the virus and experiencing severe outcomes, patients with rheumatoid arthritis (RA) remain at a higher risk for contracting the virus and experiencing severe outcomes compared with the general population, according to new study findings.

Based on their findings, the researchers are emphasizing the importance of receiving a booster vaccination, as well as following other mitigation strategies, such as social distancing and wearing face masks.

“A recent systematic review and meta-regression analysis found that COVID-19 vaccine efficacy or effectiveness decreased somewhat by six months after vaccination, underscoring the importance of evaluating vaccine efficacy or effectiveness against severe outcomes beyond six months,” detailed the researchers. “However, to date, there is a paucity of data on the risk of SARS-COV-2 infection and severe outcomes (leading to hospitalization or death) after COVID-19 vaccination in patients with RA, leaving knowledge gaps regarding the need for booster vaccinations and adherence to other risk mitigation strategies after vaccination especially beyond six months.”

The researchers analyzed data from 2 cohorts of people throughout the United Kingdom—an unvaccinated cohort of 15,000 patients with RA and 1.6 million people from the general population and a vaccinated cohort of 14,000 patients with RA and 1.2 million people from the general population. While receiving the vaccination was associated with a significantly lower risk of infection, hospitalization, and death, the risks for patients with RA still exceeded those for the general population over the 9 months of follow-up.

In both the unvaccinated and vaccinated cohort, patients with RA faced a higher incidence rate of COVID-19 compared with the general population. At 3 months, the fully weighted incidence rate in the unvaccinated cohort was 9.21 vs. 8.16/1000 person-months, respectively. At 9 months, the fully weighted incidence rate in the vaccinated cohort was 4.17 vs 3.96/1000 person-months, respectively).

Similar trends were seen among hospitalization rates, with higher hospitalization rates at 3 months for patients with RA in the unvaccinated group (3.46 vs. 2.14/1000 person-months) and at 9 months for patients with RA in the vaccinated group (0.42 vs. 0.32/1000 person-months).

“Although studies have shown that vaccination for SARS-CoV-2 was immunogenic in the majority of patients with autoimmune inflammatory rheumatic diseases, such immune responses among these patients were often blunted when compared to people without these conditions,” explained the researchers. “A retrospective cohort study analyzed data from the National COVID Cohort Collaborative (N3C) found that patients with RA had a noticeable higher rate of breakthrough infection than those without immune dysfunction. Patients included in that study were recruited from academic medical centers only; thus, the findings may not be generalizable to the general population. In addition, that study did not examine the association between RA and the risk of severe outcomes of COVID-19 sequalae.”

The researchers noted the small number of COVID-19 deaths among vaccinated patients in the study, limiting their ability to detect a small increased risk of the outcome. Among the unvaccinated, patients with RA were more likely to die from COVID-19, with a weighted incidence rate of 1.19/1000 person-months compared with 0.62/1000 person-months for the general population.

Reference

Li H, Wallace Z, Sparks J, et al. Risk of COVID-19 among unvaccinated and vaccinated patients with rheumatoid arthritis: a general population study. Arthritis Care Res. Published online September 26, 2022. doi:10.1002/acr.25028