Breakthrough SARS-CoV-2 infection in fully vaccinated patients with systemic lupus erythematosus: results from the COVID-19 Vaccination in Autoimmune Disease (COVAD) study

• DOI: 10.1007/s00296-024-05682-6
• Publication Date: 2024-08-13T18:02:24Z
• Authors: Leonardo Palazzo; Julius Lindblom; Emelie Kihlgren O...; Elena Nikiphorou; Chris Wincup; Sreoshy Saha; Syahrul Sazliyana...; Wanruchada Katcha...; Phonpen Akarawatc...; Lisa Traboco; Yi-Ming Chen; James B. Lilleker; Arvind Nune; John D. Pauling; Vishwesh Agarwal; Dey Dzifa; Carlos Enrique To...; Carlo V. Caballer...; Hector Chinoy; ; Bhupen Barman; Yogesh Preet Singh; Rajiv Ranjan; Avinash Jain; Sapan C. Pandya; Rakesh Kumar Pilania; Aman Sharma; Manesh Manoj M; Vikas Gupta; Chengappa G. Kava...; Pradeepta Sekhar ...; Sajal Ajmani; Sanat Phatak; Rudra Prosad Goswami; Abhra Chandra Cho...; Ashish Jacob Mathew; Padnamabha Shenoy; Ajay Asranna; Keerthi Talari Bo...; Anuj Shukla; Arun Kumar R. Pandey; Kunal Chandwar; Sinan Kardes; Döndü Üsküdar Cansu; Minchul Kim; Ashima Makol; Tulika Chatterjee; John D. Pauling; Chris Wincup; Lorenzo Cavagna; Nicoletta Del Papa; Gianluca Sambataro; Atzeni Fabiola; Marcello Govoni; Simone Parisi; Elena Bartoloni B...; Gian Domenico Seb...; Enrico Fusaro; Marco Sebastiani; Luca Quartuccio; Franco Franceschini; Pier Paolo Sainaghi; Giovanni Orsolini; Rossella De Angelis; Maria Giovanna Da...; Vincenzo Venerito; Marcin Milchert; Lisa S. Traboco; Suryo Anggoro Kus...; Erick Adrian Zamo...; Jorge Rojas Serrano; Ignacio García-De...; Jesús Loarce-Martos; Sergio Prieto-Gon...; Albert Gil-Vila; Raquel Aranega Go...; Masataka Kuwana; Akira Yoshida; Ran Nakashima; Shinji Sato; Naoki Kimura; Yuko Kaneko; Johannes Knitza; Stylianos Tomaras; Margarita Aleksan...; Or Aharonov; Tamer A. Gheita; Ihsane Hmamouchi; Leonardo Santos Hoff; Margherita Giannini; Francois Maurier; Julien Campagne; Alain Meyer; Melinda Nagy-Vincze; Daman Langguth; Vidya Limaye; Merrilee Needham; Nilesh Srivastav; Marie Hudson; Océane Landon-Car...; Syahrul Sazliyana...; Wilmer Gerardo Ro...; José António Pere...; João Eurico Fonseca; Olena Zimba; Vikas Agarwal; Latika Gupta; Ioannis Parodis
• Keywords: Autoimmune disease; Breakthrough infection; COVID-19; Rheumatology; Survey; Systemic lupus erythematosus; Vaccination.; Male; Adult; COVID-19 Vaccines; Breakthrough Infections; SARS-CoV-2; Vaccination; 610; COVID-19; 600; Systemic lupus erythematosu; Observational Research; Middle Aged; Breakthrough infection; Autoimmune Diseases; Rheumatology; Case-Control Studies; Rheumatic Diseases; Autoimmune disease; Humans; Lupus Erythematosus, Systemic; Female; Survey; Aged

Abstract Objective To determine the occurrence of breakthrough COVID-19 infections (BIs) in patients with systemic lupus erythematosus (SLE) compared with patients with other rheumatic autoimmune diseases (rAIDs), patients with non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HCs).

Methods The study was based on data from 7035 fully vaccinated respondents to the online COVAD questionnaire with SLE (N = 852), rAIDs (N = 3098), or nrAIDs (N = 414), and HCs (N = 2671). BI was defined as COVID-19 infection occurring in individuals vaccinated with ≥ 2 doses (or 1 dose of J&J) ≥ 14 days after vaccination and not after 6 months since the last vaccine dose. Data were analysed using linear and logistic regression models.

Results A total of 91/852 (10.7%) SLE patients reported at least one BI. The frequency of BIs in SLE patients was comparable to that among HCs (277/2671; p = 0.847) and patients with nrAID (39/414; p = 0.552) but higher than that among patients with other rAIDs (235/3098; p = 0.005). No demographic factors or treatments were associated with BIs in SLE patients (p ≥ 0.05 for all). Joint pain was more frequent in SLE patients than in HCs (odds ratio [OR]: 3.38; 95% confidence interval [CI]: 1.89–6.04; p < 0.001) or nrAID patients (OR: 2.44; 95% CI: 1.04–5.75; p = 0.041). Patient with SLE did not report a higher frequency of hospitalisation or need for advanced treatment for COVID-19 infection compared with disease controls and HCs, respectively.

Conclusion COVID-19 vaccination conferred similar protection against COVID-19 infection in terms of frequency and severity in patients with SLE to that reported by healthy individuals.