OP0081 PREVALENCE, CHARACTERISTICS, AND PREDICTORS OF BREAKTHROUGH COVID-19 INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE COVID-19 VACCINATION IN AUTOIMMUNE DISEASE (COVAD) STUDY

Abstract

BackgroundGlobal data on COVID-19 breakthrough infections (BI) following COVID-19 vaccination among autoimmune rheumatic diseases (AIRDs) and especially rheumatoid arthritis (RA) is scarce.ObjectivesThis study aimed to examine the characteristics of COVID-19 BI among patients with RA and compare them with AIRDs and healthy controls (HCs).MethodsA global e-survey, January-May 2022, collected data on COVID-19 vaccination, and BI in patients with RA, AIRDs, non-rheumatic autoimmune disease (nrAIDs), and HCs. BI was defined as infection after both primary or booster vaccine doses. Severe BI was defined as the need for hospitalization, including intensive unit care, oxygen therapy, or advanced treatment in the form of monoclonal antibodies.ResultsOf the 9595 vaccinated respondents of the e-survey, 3224 (33.6%) reported COVID-19. One BI was reported in 323/1802 (17.9%) patients with RA, 584/3869 (15.0%) patients with other AIRDs, and 467/3435 (13.5%) HCs. Similarly, second BI was reported by 280 (8.6%); 42 (2.3%) among RA, 90 (2.3%) among other AIRDs, and 124 (3.6%) among HCs.The prevalence of first BI in patients with RA was higher than that in those with AIRDs (OR=1.2; 95%CI=1.1-1.4; p=0.001) and HCs (OR=1.4; 95%CI=1.2-1.6; p<0.001), but similar to nrAIDs (p=0.783). The prevalence of second BI was lower in patients with RA than in HCs (OR=0.6; 95%CI=0.4-0.9; p=0.012) and nrAIDs (OR=0.4; 95%CI=0.2-0.7; p=0.004), but similar to AIRDs (p=0.991). When compared with HCs, patients with RA reported significantly higher joint pain, hospitalizations, and need for advanced treatment at first BI. Patients with RA from very high HDI countries had lower hazard of first BI than those from high HDI countries (HR=0.026; 95%CI=0.001-0.6; p=0.027). Rituximab use predicted more frequent hospitalization (OR=3.4; 95%CI=1.3-11.4; p=0.045) and severe BI (OR=3.0; 95%CI=1.2-7.3; p=0.014).ConclusionNearly one in five patients with RA reported BI. BI prevalence was higher in patients with RA and of higher severity than in HCs. Country HDI was an important determinant of outcomes, suggesting potential impact of environmental dynamics, local vaccination policy, and syndemic constructs that merit further exploration. Rituximab use predicted more frequent hospitalizations and more severe BI.Figure 1.A. Flow chart of respondents, 1B. Survival analysis between RA, AIRDs, nrAIDs, and HCREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNaveen Ravichandran: None declared, Ioannis Parodis Grant/research support from: IP has received research funding and/or honoraria from Amgen, AstraZeneca, Aurinia Pharmaceuticals, Elli Lilly and Company, Gilead Sciences, GlaxoSmithKline, Janssen Pharmaceuticals, Novartis and F. Hoffmann-La Roche AG., Latika Gupta: None declared, Samuel Katsuyuki Shinjo: None declared, Nelly Ziade Speakers bureau: NZ has received speaker fees, advisory board fees, and research grants from Pfizer, Roche, Abbvie, Eli Lilly, NewBridge, Sanofi-Aventis, Boehringer Ingelheim, Janssen, and Pierre Fabre; none are related to this manuscript., Grant/research support from: NZ has received speaker fees, advisory board fees, and research grants from Pfizer, Roche, Abbvie, Eli Lilly, NewBridge, Sanofi-Aventis, Boehringer Ingelheim, Janssen, and Pierre Fabre; none are related to this manuscript., Marcin Milchert: None declared, Lorenzo Cavagna: None declared, Ai Lyn Tan: None declared, James B. Lilleker: None declared, Arvind Nune: None declared, John Pauling: None declared, Chris Wincup: None declared, Wanruchada Katchamart: None declared, Phonpen Akarawatcharangura Goo: None declared, COVAD Study: None declared, Hector Chinoy: None declared, Rohit Aggarwal Consultant of: 1. Mallinckrodt 2. Octapharma 3. CSL Behring 4. Bristol Myers-Squibb 5. EMD Serono 6. Kezar 7. Pfizer 8. AstraZeneca 9. Alexion 10. Argenx 11. Boehringer Ingelheim (BI) 12. Corbus.13. Janssen 14. Kyverna 15. Roivant 16. Merck 17. Galapagos 18. Actigraph 19. Abbvie 20. Scipher 21. Horizontal Therapeutics 22. Teva 23. Biogen 24. Beigene 25. ANI Pharmaceutical 26. Nuvig 27. Capella 28. CabalettaBio, Grant/research support from: 1. Mallinckrodt 2. Pfizer 3. Bristol Myers-Squibb 4. Q32 5. EMD Serono 6. Janssen 7. Boehringer Ingelheim (BI), Vikas Agarwal: None declared, Elena Nikiphorou Speakers bureau: EN has received speaker honoraria/participated in advisory boards for Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, and Lilly, and holds research grants from Pfizer and Lilly.