POS1255 REACTOGENICITY OF SARS-COV-2 VACCINES IN PATIENTS WITH AUTOIMMUNE AND INFLAMMATORY DISEASE

Single-center experience of COVID-19 vaccine in patients with inflammatory rheumatic disease: Real-life data

Background/Aim: Patients with rheumatic disease are at high risk of infection complications, and vaccines are essential to prevent these diseases. Moreover, biologic disease-modifying/targeted synthetic anti-rheumatic drugs (b/tsDMARDs) have been shown to reduce the immunogenicity of vaccines, although their effectiveness, side effects, and effects on disease activity are not yet clear. In this study, we aimed to investigate the incidence of post-vaccine side effects, disease exacerbation, and COVID-19 infection despite vaccination in patients with inflammatory rheumatic disease; the difference in vaccination effects between patients who received and did not receive b/tsDMARD treatments. Methods: Patients received b/tsDMARD (i.e., biologic group (BG)) (n = 194) who were admitted to the rheumatology outpatient clinic, were included in this study. All patients with inflammatory rheumatological disease, who did not receive b/tsDMARD (n = 185), but who applied to the rheumatology outpatient clinic during this time, were included in the non-biologic group (NG). Patients followed were included and evaluated cross-sectionally. Clinical and demographic characteristics, as well as type of COVID-19 vaccination, post-vaccine side effects, COVID-19 infection status before and after vaccination, and post-vaccine rheumatological disease exacerbation, were also evaluated. Results: In BG, 92.2% of patients were vaccinated, but for NG, 82.7% were vaccinated against COVID-19 patients with BG, 46.2% were vaccinated with CoronaVac vaccine alone, 51.4% with Pfizer/BioNTech BNT162b2 vaccine alone, and 37.4% with a combination of CoronaVac and BNT162b2 vaccines. In the NG, 53.8% of patients were vaccinated with CoronaVac vaccine alone, 48.6% with BNT162b2 vaccine alone, and 36.2% with a combination of CoronaVac and BNT162b2 vaccines. There was a significant difference between groups, according to vaccine types (P = 0.040), as this difference was due to a larger number of patients vaccinated with the CoronaVac + BNT162b2 combination for BG. Adverse effects were detected in 99 patients (55.9%) with BG and 95 patients (62.5%) with NG post-vaccination. There was no difference between BG and NG vaccines (CoronaVac, BNT162b2, or their combination) for adverse effects (P > 0.05 for all). The vaccine with the most common adverse events was BNT162b2, for both BG and NG. The most common side effect was arm pain, significantly higher in BG (P = 0.014). Fever and rash were more common for NG (P = 0.017). Disease exacerbation was not observed with BG, whereas it was detected in 5 (1%) patients for NG that was different (P = 0.021). SARS-COV-2 infection was also significantly less common for BG vs. NG (15.3% vs. 20.3%) (P = 0.017). Despite COVID-19 vaccinations, 56 patients with BG and 62 patients with NG had COVID-19 (P = 0.005). Conclusion: Standardized vaccination comparisons could not be achieved, as patients using b/tsDMARD were vaccinated for fewer COVID-19 infections. Additionally, COVID-19 vaccines are well-tolerated in patients with rheumatological disease, with vaccine-related disease activity at 1%, only seen in those not using b/tsDMARDs.

Immunogenicity, Effectiveness, and Safety of COVID-19 Vaccines in Rheumatic Patients: An Updated Systematic Review and Meta-Analysis

Background: Vaccination is one of the most important measures worldwide to halt the spread of the corona virus disease 2019 (COVID-19). However, the efficacy and safety of these vaccines in rheumatic patients are not well explored. Therefore, we conducted a systematic review and meta-analysis. Methods: We performed a literature search of the PubMed and EMBASE databases on 17 November 2021. Forty-seven studies relevant to the immunogenicity, efficacy/effectiveness, and safety of COVID-19 vaccines were selected. Results: Our results demonstrated that COVID-19 vaccination is effective in protecting rheumatic patients from severe illness caused by the virus. Both the humoral and cellular immunogenicity of vaccines were impaired in rheumatic patients, which were greatly enhanced after the second vaccine dose. Receiving anti-CD20 therapy was associated with impaired humoral immunogenicity. Adverse events due to COVID-19 vaccines in rheumatic patients were similar to those in healthy controls, except for an increased incidence of arthralgia. The incidence of disease flares after COVID-19 vaccination was low. Conclusion: Our systematic review indicated the importance of full vaccination in rheumatic patients. Withholding anti-CD20 therapy was found to be potentially beneficial for the immunogenicity. Furthermore, the vaccines were found to be safe in general. Despite significant heterogeneity between studies, we recommend that rheumatic patients receive these vaccines amidst the global pandemic.