Fully vaccinated people with systemic rheumatic diseases have less severe COVID outcomes

Breakthrough COVID-19 had lower hospitalisation and mortality in vaccinated patients

INTRODUCTION
COVID-19 is the disease caused by a new type of coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It was declared a pandemic by the World Health Organization on 11 March 2020. COVID-19 has forced people to change their behaviours to try to limit the spread of infection. There are many types of systemic rheumatic diseases. For example, this group includes types of inflammatory arthritis that affect a person’s joints, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, and gout. Other types include connective tissue diseases and vasculitis, where the inflammation affects a person’s blood vessels. Some studies have suggested that vaccines might not work as well in people with systemic rheumatic diseases. This might be because of changes in a person’s immune system with these kinds of diseases, but can also be due to treatment with drugs which have an impact on the immune system. COVID-19 infections that happen after vaccination are called a breakthrough infection.

WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to see the protective effect of vaccines in people with systemic rheumatic disease, and work out whether it is the same as that in the general population.

WHO WAS STUDIED?
The study looked at 195 people living with a systemic rheumatic disease who had caught COVID-19. Of these, 147 were unvaccinated, and 48 had been vaccinated with at least one dose of a COVID-19 vaccine. Everyone was being looked after at a clinic in Greece, and had their information recorded in a database.

HOW WAS THE STUDY CONDUCTED?
The study was based on people included in a registry database. People in a registry are not randomised to receive any particular drug, but instead are simply observed and their data recorded.
The authors looked at COVID-19 outcomes and compared them between the vaccinated and unvaccinated groups.

WHAT WAS THE MAIN FINDING?
Among those who had been vaccinated, 60% developed their breakthrough COVID-19 infection more than 14 days after their second vaccine dose – these people were classed as fully vaccinated. The other 40% were infected at some point after getting their first vaccine dose, and within 14 days after the second dose (partially vaccinated). The results showed the need for hospital admission was higher in people who were unvaccinated. For those who were fully vaccinated, 10% needed hospital admission for COVID-19, compared to 21% for those who were partially vaccinated, and 29% of those who had not been vaccinated at all against COVID-19. The chance of dying was also higher in people who were unvaccinated. For those who were fully or partially
vaccinated the risk of dying was 0%, compared to 4% for those who had not been vaccinated.

ARE THESE FINDINGS NEW?
Yes, this was the first study to showed that people with a systemic rheumatic disease have better outcomes if they catch COVID-19 after receiving at least one dose of a vaccine against the SARS-CoV-2 virus.

WHAT ARE THE LIMITATIONS OF THIS STUDY?
One limitation is the non-interventional study design. The authors also did not have access to blood samples, so they were not able to measure the immune response. Also, this study was conducted between 1 March 2020 and 31 August 2021, which could mean the results only apply to the SAR-CoV-2 variants that were active at that time.

WHAT DO THE AUTHORS PLAN TO DO WITH THIS INFORMATION?
The authors have also conducted another study that showed the protective effects of a third dose of vaccine against SARS-CoV-2 in subsequent time periods.

WHAT DOES THIS MEAN FOR ME?
If you have a systemic rheumatic disease, the best protection against COVID-19 is getting vaccinated. Protect yourself from COVID-19 by following the advice of the government in your country. Where recommended, follow social distancing rules, and use protective masks. Wash your hands regularly, and avoid touching your face. Maintaining good ventilation may also help stop the virus spreading.

ADDITIONAL READING
Fragoulis GE, et al. Clinical outcomes of breakthrough COVID-19 after booster vaccination in patients with systemic rheumatic diseases. RMD Open 2022;8(1):e002279. doi:10.1136/rmdopen-2022-002279.

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Date prepared: June 2022
Summary based on research article published on: 10 November 2021
From: Papagoras C, et al. Better outcomes of COVID-19 in vaccinated compared to unvaccinated patients with systemic rheumatic diseases. Ann Rheum Dis 2022;81(7):1013–16. doi:10.1136/annrheumdis-2021-221539

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