COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Data Sources/Measurement
2.3. Sample Size
2.4. Data Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Patients with and without Flare | Vaccinated and Non-Vaccinated Patients | |||||||
---|---|---|---|---|---|---|---|---|
Flare-Up (n = 42) | Non-Flare-Up (n = 581) | p Value | Missing | Vaccinated (n = 416) | Non-Vaccinated (n = 207) | p Value | Missing | |
Enrolled online | 31 (73.8%) | 30 (63.7%) | 0.243 | 299 (71.9%) | 102 (49.3%) | <0.001 | ||
Vaccinared | 25 (59.5%) | 391 (67.3%) | 0.312 | - | - | - | ||
Gender (F) | 37 (88.1%) | 485 (83.5%) | 0.522 | 339 (81.5%) | 183 (88.4%) | 0.028 | ||
Age (y) | 46 (21, 83) | 49 (19, 88) | 0.126 | 50 (21, 88) | 48 (19, 73) | 0.290 | ||
Immune disease and comorbidities | ||||||||
Charlson index | 2 (0, 6) | 1 (0, 10) | 0.512 | 1 (0, 9) | 1 (0, 10) | 0.354 | ||
More than one immune disease | 16 (38.1%) | 118 (20.3%) | 0.011 | 83 (20%) | 51 (24.6%) | 0.180 | ||
Number of immune diseases/patient | 1 (1, 4) | 1 (1, 6) | 0.006 | 1 (1, 4) | 1 (1, 6) | 0.142 | ||
Immune pulmonary involvement | 6 (14.3%) | 59 (10.2%) | 0.429 | 40 (9.6%) | 25 (12.1%) | 0.404 | ||
AIRD 1 | 26 (61.9%) | 369 (63.5%) | 0.869 | 239 (57.5%) | 156 (75.4%) | <0.001 | ||
Rheumatoid arthritis | 7 (16.7%) | 91 (15.7%) | 0.827 | 59 (14.2%) | 39 (18.8%) | 0.161 | ||
Systemic lupus erythematosus | 9 (21.4%) | 88 (15.1%) | 0.273 | 48 (11.5%) | 49 (23.7%) | <0.001 | ||
Sjögren’s syndrome/Sicca 2 | 7 (16.7%) | 71 (12.2%) | 0.466 | 50 (12%) | 28 (13.5%) | 0.608 | ||
Ankylosing spondylitis | 2 (4.8%) | 63 (10.8%) | 0.298 | 48 (11.5%) | 17 (8.2%) | 0.214 | ||
Psoriatic arthritis/psoriasis | 4 (9.5%) | 49 (8.4%) | 0.774 | 32 (7.7%) | 21 (10.1%) | 0.360 | ||
Systemic sclerosis/limited scleroderma | 1 (2.4%) | 30 (5.2%) | 0.714 | 14 (3.4%) | 17 (8.2%) | 0.011 | ||
Antiphospholipid syndrome | 3 (7.1%) | 22 (3.8%) | 0.234 | 12 (2.9%) | 13 (6.3%) | 0.051 | ||
Systemic vasculitis | 2 (4.8%) | 15 (2.6%) | 0.320 | 8 (1.9%) | 9 (4.3%) | 0.114 | ||
Other AIRD 3 | 1 (2.4%) | 14 (2.4%) | 1 | 9 (2.2%) | 6 (2.9%) | 0.586 | ||
Non-AIRD | 16 (38.1%) | 212 (36.5%) | 0.869 | 177 (42.5%) | 51 (24.6%) | <0.001 | ||
Inflammatory bowel disease | 5 (11.9%) | 39 (6.7%) | 0.207 | 34 (8.2%) | 10 (4.8%) | 0.138 | ||
Celiac disease | 1 (2.4%) | 18 (3.1%) | 1 | 14 (3.4%) | 5 (2.4%) | 0.626 | ||
Primary biliary cholangitis | 1 (2.4%) | 8 (1.4%) | 0.469 | 4 (1%) | 5 (2.4%) | 0.167 | ||
Autoimmune hepatitis | 0 (0%) | 11 (1.9%) | 1 | 8 (1.9%) | 3 (1.4%) | 1 | ||
Myasthenia gravis | 6 (14.3%) | 22 (3.8%) | 0.008 | 15 (3.6%) | 13 (6.3%) | 0.151 | ||
Multiple sclerosis | 1 (2.4%) | 24 (4.1%) | 1 | 17 (4.1%) | 8 (3.9%) | 1 | ||
Hematological diseases 4 | 1 (2.4%) | 4 (0.7%) | 0.295 | 4 (1%) | 1 (0.5%) | 1 | ||
Cutaneous diseases 5 | 1 (2.4%) | 16 (2.8%) | 1 | 12 (2.9%) | 5 (2.4%) | 1 | ||
Autoimmune thyroid disease | 9 (21.4%) | 128 (22%) | 1 | 109 (26.2%) | 28 (13.5%) | <0.001 | ||
Other non-AIRD 6 | 6 (14.3%) | 44 (6.7%) | 0.136 | 40 (9.6%) | 10 (4.8%) | 0.042 | ||
Treatment | ||||||||
Corticosteroids | 16 (38.1%) | 120 (20.7%) | 0.012 | 71 (17.1%) | 65 (31.4%) | <0.001 | ||
Corticosteroid dose (mg) | 10 (5, 45) | 10 (2,5, 40) | 0.015 | 29 | 6.25 (5, 20) | 10 (3, 45) | <0.001 | 29 |
Synthetic DMARDs 7 | 12 (28.6%) | 226 (38.9%) | 0.194 | 143 (34.4%) | 95 (45.9%) | 0.007 | ||
Hydroxychloroquine | 8 (19%) | 125 (21.5%) | 0.846 | 81 (19.5%) | 52 (25.1%) | 0.119 | ||
Methotrexate | 2 (4.8%) | 64 (11%) | 0.298 | 42 (10.1%) | 24 (11.6%) | 0.582 | ||
Sulfasalazine | 2 (4.8%) | 48 (8.3%) | 0.566 | 34 (8.2%) | 16 (7.7%) | 1 | ||
Leflunomide | 1 (2.4%) | 20 (3.4%) | 1 | 10 (2.4%) | 11 (5.3%) | 0.096 | ||
Biologic DMARDs 7 | 10 (23.8%) | 119 (20.6%) | 0.561 | 89 (21.4%) | 40 (19.4%) | 0.600 | ||
Mycophenolate mofetil | 1 (2.4%) | 17 (2.9%) | 1 | 13 (3.1%) | 5 (2.4%) | 0.801 | ||
Azathioprine | 5 (11.9%) | 40 (6.9%) | 0.216 | 23 (5.5%) | 22 (10.6%) | 0.031 | ||
Flare-up-related variables | ||||||||
Disease diagnosis-enrollement/vaccine (years) | 11 (1, 40) | 9 (0, 56) | 0.608 | 29 | 9 (0, 50) | 10 (0, 56) | 0.999 | 29 |
Flare-up in the year prior enrolement/vaccination | 22 (73.3%) | 189 (47.4%) | 0.007 | 194 | 130 (46.8%) | 81 (53.6%) | 0.189 | 194 |
Enrollment/vaccination-flare-up timelaps (months) | - | - | - | 6.13 (0, 8) | 5.57 (1, 8) | <0.001 | ||
COVID-19 8 prior enrollement/vaccine | 4 (9.5%) | 81 (13.9%) | 0.640 | 75 (18%) | 10 (4.8%) | <0.001 | ||
Adverse events after dose 1 | 24 (92.3%) | 283 (72.4%) | 0.022 | 307/416 | - | - | ||
Adverse events after dose 2 | 21 (80.8%) | 252 (64.5%) | 0.134 | 273/416 | - | - | ||
Treatment adjustment before vaccination | 4 (16%) | 27 (6.9%) | 0.105 | 31/416 | - | - | ||
Treatment adjustment before flare | 3/42 (7.1%) | - | - | 1 (4%) | 2 (11.8%) | 0.556 | ||
Average length of flare-up (days) | 30 (4, 164) | - | - | 4 | 30 (4, 149) | 27.5 (14, 164) | 0.803 | 4 |
Still having flare-up at the last assessment | 19 (45.2%) | 18 (3.2%) | <0.001 | 21 | 18 (4.5%) | 19 (9.6%) | 0.018 | 21 |
Flare-up management | ||||||||
Hospitalization | 15/42 | - | - | 10/25 | 5/17 | - | ||
Treatment adjustment | 36/42 | - | - | 21/25 | 15/17 | - |
1st Dose (n = 416) | 2nd Dose (n = 407) | |||||||
---|---|---|---|---|---|---|---|---|
Non-AIRD 1 (n = 134, 75.7%) | AIRD (n = 173, 72.4%) | p Value (0.499) | Total Adverse Events (n = 307) | Non-AIRD (n = 125, 70.6%) | AIRD (n = 148, 61.9%) | p Value (0.076) | Total Adverse Events (n = 273) | |
Pain in injection site | 81 (45.3%) | 99 (41.4%) | 0.485 | 180 | 86 (48%) | 82 (34.3%) | 0.005 | 168 |
Local swelling | 9 (5%) | 6 (2.5%) | 0.192 | 15 | 6 (3.4%) | 4 (1.7%) | 0.338 | 10 |
Local redness | 22 (12.3%) | 23 (9.6%) | 0.427 | 45 | 8 (4.5%) | 7 (2.9%) | 0.435 | 15 |
Fatigue | 46 (25.7%) | 51 (21.3%) | 0.349 | 97 | 41 (22.9%) | 52 (21.8%) | 0.813 | 93 |
Headache | 33 (18.4%) | 44 (18.4%) | 1 | 77 | 24 (13.4%) | 25 (10.5%) | 0.361 | 49 |
Myalgia | 24 (13.4%) | 35 (14.6) | 0.777 | 59 | 25 (14%) | 25 (10.5%) | 0.289 | 50 |
New/increased joint pain | 25 (14%) | 35 (14.7%) | 0.888 | 60 | 10 (5.6%) | 20 (8.4%) | 0.340 | 30 |
Chills | 24 (13.4%) | 35 (14.6%) | 0.777 | 59 | 28 (15.6%) | 34 (14.5%) | 0.782 | 62 |
Fever | 8 (4.5%) | 13 (5.4%) | 0.822 | 21 | 22 (12.3%) | 24 (10%) | 0.528 | 46 |
Allergic reactions | 3 (1.7%) | 2 (0.8%) | 0.655 | 5 | 1 (0.6%) | 0 (0%) | 0.427 | 1 |
Skin rash | 3 (1.7%) | 3 (1.3%) | 1 | 6 | 1 (0.6%) | 0(0%) | 0.428 | 1 |
Anaphylactic shock | 0 (0%) | 0 (0%) | 0 | 0 | 0 (0%) | 1 (0.4%) | 1 | 1 |
Lymphadenopathy | 4 (2.2%) | 5 (2.1%) | 1 | 9 | 5 (2.9%) | 4 (1.7%) | 0.501 | 9 |
Paresthesia | 1 (0.6%) | 6 (2.5%) | 0.247 | 7 | 2 (1.2%) | 5 (2.1%) | 0.704 | 7 |
Digestive symptoms | 4 (2.2%) | 5 (2.1%) | 1 | 9 | 7 (4%) | 12 (5%) | 0.813 | 19 |
Dizziness | 2 (1.1%) | 7 (2.9%) | 0.311 | 9 | 6 (3.5%) | 6(2.5%) | 0.569 | 12 |
Cough | 3 (1.7%) | 0 (0%) | 0.078 | 3 | 1 (0.6%) | 0 (0%) | 0.420 | 1 |
Variable | B | p | OR with 95%CI 1 |
---|---|---|---|
More than one immune disease | 0.667 | 0.079 | 1.9 (0.92–4.09) |
Corticotherapy | 0.438 | 0.255 | 1.5 (0.73–3.3) |
Vaccine | −0.630 | 0.094 | 0.53 (0.25–1.11) |
Flare-up during the previous year | 0.972 | 0.019 | 2.64 (1.17–5.97) |
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Pinte, L.; Negoi, F.; Ionescu, G.D.; Caraiola, S.; Balaban, D.V.; Badea, C.; Mazilu, D.; Dumitrescu, B.; Mateescu, B.; Ionescu, R.; et al. COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases. J. Pers. Med. 2021, 11, 1283. https://doi.org/10.3390/jpm11121283
Pinte L, Negoi F, Ionescu GD, Caraiola S, Balaban DV, Badea C, Mazilu D, Dumitrescu B, Mateescu B, Ionescu R, et al. COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases. Journal of Personalized Medicine. 2021; 11(12):1283. https://doi.org/10.3390/jpm11121283
Chicago/Turabian StylePinte, Larisa, Florentina Negoi, Georgeta Daniela Ionescu, Simona Caraiola, Daniel Vasile Balaban, Camelia Badea, Diana Mazilu, Bianca Dumitrescu, Bogdan Mateescu, Ruxandra Ionescu, and et al. 2021. "COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases" Journal of Personalized Medicine 11, no. 12: 1283. https://doi.org/10.3390/jpm11121283
APA StylePinte, L., Negoi, F., Ionescu, G. D., Caraiola, S., Balaban, D. V., Badea, C., Mazilu, D., Dumitrescu, B., Mateescu, B., Ionescu, R., Parvu, M. I., & Baicus, C. (2021). COVID-19 Vaccine Does Not Increase the Risk of Disease Flare-Ups among Patients with Autoimmune and Immune-Mediated Diseases. Journal of Personalized Medicine, 11(12), 1283. https://doi.org/10.3390/jpm11121283