Breakthrough COVID-19 in vaccinated patients linked to B-cell therapies, mycophenolate
Among fully vaccinated individuals with rheumatic diseases, breakthrough COVID-19 infections occurred most commonly in patients treated with B cell depleting agents or mycophenolate, according to data presented at ACR Convergence 2021.
“COVID-19 vaccination is recommended and usually well tolerated and efficacious among people with rheumatic disease,” Jean Liew, MD, of the Boston University School of Medicine, said in her presentation. “However, laboratory-based studies using surrogate markers of protection against COVID-19 have demonstrated reduced vaccine immunogenicity in people on certain immunosuppressed medications.”
With that in mind, Liew and colleagues analyzed clinical characteristics of patients reported to the COVID-19 Global Rheumatology Alliance registry who developed COVID-19 after vaccination against SARS-CoV-2.
The analysis included 197 fully or partially vaccinated patients with rheumatic diseases who reported infection between Jan. 5, 2021 and Sept. 30, 2021. Partial vaccination was defined as being 14 days or fewer after the first dose of a two-dose regimen or within 13 days of a single dose regimen, while full vaccination was defined as infection occurring 14 or more days after the second in a two-dose regimen or 2 weeks after a single shot regimen.
Patient demographic and clinical information were factored into the analysis. The mean age of the cohort was 53 years. Data showed that 73% of the cohort was female, while 55% were white.
Rheumatoid arthritis (RA) was reported in 43.2% of patients, with 15.4% having systemic lupus erythematosus (SLE), 9.6% having psoriatic arthritis (PsA) and 8.6% having vasculitis. Hypertension was the most commonly occurring comorbidity, along with lung disease and obesity. Among these patients, 28% were on methotrexate, 28% were on B cell-depleting therapies, 28% were on mycophenolate and 23% were on other biologic DMARDs. Most patients had received an mRNA vaccine product.
Overall, 51 participants were hospitalized for COVID infection. There were nine fatalities overall.
“Among the fully vaccinated, COVID infection occurred a mean of 112 days after the second dose,” Liew said. She added that 22 fully vaccinated patients were hospitalized. Of those fully vaccinated, hospitalized patients, nine were receiving CD20 inhibitors and seven patients were being treated with mycophenolate.
“We did not find meaningful differences in glucocorticoid use among breakthrough infections by hospitalization status,” Liew said. The study included few patients on other medications such as tumor necrosis factor (TNF) inhibitors or methotrexate.”
“These findings support prior laboratory data that people on certain rheumatic disease medications, such as CD20 inhibitors and mycophenolate, may be at higher risk for poor outcomes of breakthrough COVID-19 infections vs. the general population,” Liew concluded. “Additional risk mitigation strategies, including additional vaccine doses, monoclonal antibody treatment and, possibly, oral antivirals, may be needed to protect this high-risk population.”