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Delayed adverse events following COVID-19 vaccination in patients with systemic sclerosis and other autoimmune diseases: a substudy of the COVAD-2 cohort

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Abstract

Data on short-term safety of COVID-19 vaccination in patients with systemic sclerosis (SSc) were explored previously in the first COVID-19 vaccination in autoimmune diseases (COVAD) survey conducted in 2021. However, delayed adverse events (ADEs) (occurring > 7 days post-vaccination) are poorly characterized in these patients with SSc. In this study, we analysed delayed COVID-19 vaccine-related ADEs among patients with SSc, other systemic autoimmune and inflammatory disorders (SAIDs) and healthy controls (HCs) using data from the second COVAD study conducted in 2022. The COVAD-2 study was a cross-sectional, patient self-reported global e-survey conducted from February to June 2022. Data on demographics, SSc/SAID disease characteristics, COVID-19 infection history, and vaccination details including delayed ADEs as defined by the Centre for Disease Control were captured and analysed. Among 17,612 respondents, 10,041 participants fully vaccinated against COVID-19 were included for analysis. Of these, 2.6% (n = 258) had SSc, 63.7% other SAIDs, and 33.7% were HCs. BNT162b2 Pfizer (69.4%) was the most administered vaccine, followed by MRNA-1273 Moderna (32.25%) and ChadOx1 nCOV-19 Oxford/AstraZeneca (12.4%) vaccines. Among patients with SSc, 18.9% reported minor, while 8.5% experienced major delayed ADEs, and 4.6% reported hospitalization. These frequencies were comparable to those of the ADEs reported by other patients with SAIDs and HCs. However, patients with SSc reported a higher frequency of difficulty in breathing than HCs [OR 2.3 (1.0–5.1), p = 0.042]. Patients with diffuse cutaneous SSc experienced minor ADEs [OR 2.1 (1.1–4.4), p = 0.036] and specifically fatigue more frequently [OR 3.9 (1.3–11.7), p = 0.015] than those with limited cutaneous SSc. Systemic sclerosis patients with concomitant myositis reported myalgia more frequently [OR 3.4 (1.1–10.7), p = 0.035], while those with thyroid disorders were more prone to report a higher frequency of joint pain [OR 5.5 (1.5–20.2), p = 0.009] and dizziness [OR 5.9 (1.3–27.6), p = 0.024] than patients with SSc alone. A diagnosis of SSc did not confer a higher risk of delayed post-COVID-19 vaccine-related ADEs overall compared with other SAIDs and HCs. However, the diffuse cutaneous phenotype and coexisting autoimmune conditions including myositis and thyroid disease may increase the risk of minor ADEs. These patients may benefit from pre-vaccination counselling, close monitoring, and early initiation of appropriate care in the post-COVID-19 vaccination period.

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Data availability statement

The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors are grateful to all respondents for completing the questionnaire. The authors also thank the Myositis Association, Myositis India, Myositis UK, Myositis Support and Understanding, the Myositis Global Network, Deutsche Gesellschaft für Muskelkranke e.V. (DGM), Dutch and Swedish Myositis patient support groups, Cure JM, Cure IBM, Sjögren’s India Foundation, Patients Engage, Scleroderma India, Lupus UK, Lupus Sweden, Emirates Arthritis Foundation, EULAR PARE, ArLAR research group, AAAA patient group, Myositis Association of Australia, APLAR myositis special interest group, Thai Rheumatism association, PANLAR, AFLAR NRAS, Anti-Synthetase Syndrome support group, and various other patient support groups and organizations for their contribution to the dissemination of this survey. Finally, the authors wish to thank all members of the COVAD study group for their invaluable role in the data collection. COVAD Study Group Authors: Naveen R, Mrudula Joshi, Arvind Nune, Sreoshy Saha, Ai Lyn Tan, Samuel Katsuyuki Shinjo, Nelly Ziade, Tsvetelina Valikova, Ioannis Parodis, Abraham Edgar Gracia-Ramos, Johannes Knitza, Yi-Ming Chen, Aarat Patel, Chris Wincup, Bhupen Barman, Erick Adrian Zamora Tehozol, Jorge Rojas Serrano, Ignacio García-De La Torre, Iris J. Colunga-Pedraza, Javier Merayo-Chalico, Okwara Celestine Chibuzo, Russka Shumnalieva, Leonardo Santos Hoff, Lina El Kibbi, Hussein Halabi, Binit Vaidya, A T M Tanveer Hasan, Carlo V Caballero-Uribe, James B. Lilleker, Babur Salim, Tamer Gheita, Miguel A Saavedra, Sinan Kardes, Laura Andreoli, Daniele Lini, Karen Schreiber, Melinda Nagy Vince, Yogesh Preet Singh, Rajiv Ranjan, Avinash Jain, Sapan C Pandya, Rakesh Kumar Pilania, Aman Sharma, Manesh Manoj M, Vikas Gupta, Chengappa G Kavadichanda, Pradeepta Sekhar Patro, Sajal Ajmani, Sanat Phatak, Rudra Prosad Goswami, Abhra Chandra Chowdhury, Ashish Jacob Mathew, Padnamabha Shenoy, Ajay Asranna, Keerthi Talari Bommakanti, Anuj Shukla, Arunkumar R Pande, Kunal Chandwar, Akanksha Ghodke, Hiya Boro, Zoha Zahid Fazal, Döndü Üsküdar Cansu, Reşit Yıldırım, Armen Yuri Gasparyan, Nicoletta Del Papa, Gianluca Sambataro, Atzeni Fabiola, Marcello Govoni, Simone Parisi, Elena Bartoloni Bocci, Gian Domenico Sebastiani, Enrico Fusaro, Marco Sebastiani, Luca Quartuccio, Franco Franceschini, Pier Paolo Sainaghi, Giovanni Orsolini, Rossella De Angelis, Maria Giovanna Danielli, Vincenzo Venerito, Silvia Grignaschi, Alessandro Giollo, Alessia Alluno, Florenzo Ioannone, Marco Fornaro, Lisa S Traboco, Suryo Anggoro Kusumo Wibowo, Jesús Loarce-Martos, Sergio Prieto-González, Raquel Aranega Gonzalez, Ran Nakashima, Shinji Sato, Naoki Kimura, Yuko Kaneko, Takahisa Gono, Stylianos Tomaras, Fabian Nikolai Proft, Marie-Therese Holzer, Margarita Aleksandrovna Gromova, Or Aharonov, Zoltán Griger, Ihsane Hmamouchi, Imane El bouchti, Zineb Baba, Margherita Giannini, François Maurier, Julien Campagne, Alain Meyer, Daman Langguth, Vidya Limaye, Merrilee Needham, Nilesh Srivastav, Marie Hudson, Océane Landon-Cardinal, Wilmer Gerardo Rojas Zuleta, Álvaro Arbeláez, Javier Cajas, José António Pereira Silva, João Eurico Fonseca, Olena Zimba, Doskaliuk Bohdana, Uyi Ima-Edomwonyi, Ibukunoluwa Dedeke, Emorinken Airenakho, Nwankwo Henry Madu, Abubakar Yerima, Hakeem Olaosebikan, Becky A., Oruma Devi Koussougbo, Elisa Palalane, Ho So, Manuel Francisco Ugarte-Gil, Lyn Chinchay, José Proaño Bernaola, Victorio Pimentel, Hanan Mohammed Fathi, Reem Hamdy A Mohammed, Ghita Harifi, Yurilís Fuentes-Silva, Karoll Cabriza, Jonathan Losanto, Nelly Colaman, Antonio Cachafeiro-Vilar, Generoso Guerra Bautista, Enrique Julio Giraldo Ho, Lilith Stange Nunez, Cristian Vergara M, Jossiell Then Báez, Hugo Alonzo, Carlos Benito Santiago Pastelin, Rodrigo García Salinas, Alejandro Quiñónez Obiols, Nilmo Chávez, Andrea Bran Ordóñez, Gil Alberto Reyes Llerena, Radames Sierra-Zorita, Dina Arrieta, Eduardo Romero Hidalgo, Ricardo Saenz, Idania Escalante M, Wendy Calapaqui, Ivonne Quezada, Gabriela Arredondo. HC was supported by the National Institution for Health Research Manchester Biomedical Research Centre Funding Scheme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, National Institute for Health Research, or Department of Health.

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No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript.

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DB, LG, and AM contributed to conceptualization. All authors performed data curation. DB carried out formal analysis; funding acquisition was N/A. LG, DB, and AM performed investigation. LG, DB, and VA provided methodology; LG provided software. VA, RA, LG, and HC performed validation. RA, VA, and LG contributed to visualization. DB, LG, and AM performed writing—original draft. All authors performed writing—review and editing. All the authors acknowledge their contribution and take full responsibility for the integrity and accuracy of the work presented. No artificial intelligence software was used in writing or editing of the present manuscript.

Corresponding author

Correspondence to Vikas Agarwal.

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Conflict of interest

ALT has received honoraria for advisory boards and speaking for Abbvie, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB. 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. HC has received grant support from Eli Lilly and UCB, consulting fees from Novartis, Eli Lilly, Orphazyme, Astra Zeneca, speaker for UCB, and Biogen. JD has received research funding from CSL Limited. JDP has undertaken consultancy work and/or received speaker honoraria from Astra Zenaca, Boehringer Ingeheim, Sojournix Pharma, Permeatus Inc, Janssen and IsoMab Pharmaceuticals. MK has received speaker honoraria/participated in advisory boards for Abbvie, Asahi-Kasei, Astellas, AstraZeneca, Boehringer-Ingelheim, Chugai, Corbus, Eisai, GSK, Horizon, Kissei, BML, Mochida, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi. 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. OD has/had consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: 4P-Pharma, Abbvie, Acceleron, Alcimed, Altavant, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galderma, Galapagos, Glenmark, Gossamer, iQvia, Horizon, Inventiva, Janssen, Kymera, Lupin, Medscape, Merck, Miltenyi Biotec, Mitsubishi Tanabe, Novartis, Prometheus, Redxpharma, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143). RA has a consultancy relationship with and/or has received research funding from the following companies: Bristol Myers-Squibb, Pfizer, Genentech, Octapharma, CSL Behring, Mallinckrodt, AstraZeneca, Corbus, Kezar, Abbvie, Janssen, Kyverna Alexion, Argenx, Q32, EMD-Serono, Boehringer Ingelheim, Roivant, Merck, Galapagos, Actigraph, Scipher, Horizon Therapeutics, Teva, Beigene, ANI Pharmaceuticals, Biogen, Nuvig, Capella Bioscience, and CabalettaBio. The rest of the authors have no conflict of interest relevant to this manuscript.

Ethical approval

Ethical approval was obtained from the Institutional Ethics Committee of SGPGIMS, Raebareli Road, Lucknow, 226014. Protocol number/IEC Code: 2021-143-IP-EXP-39.

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Disclaimer: This abstract was presented as Poster presentation in EULAR 2023 Congress: Poster number: POS1259. Citation of the abstract publication: Doskaliuk B, Sen P, Joshi M, et al. POS1259 Systemic Sclerosis And Covid-19 Vaccine-Associated Delayed Adverse Events: Insights From The Covad-2 Study. Annals of the Rheumatic Diseases 2023;82:972-973. DOI: 10.1136/annrheumdis-2023-eular.4739.

The complete list of authors part of the COVAD Study Group as well as their affiliations are provided in the Supplement.

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Panchawagh, S., Bohdana, D., Kuwana, M. et al. Delayed adverse events following COVID-19 vaccination in patients with systemic sclerosis and other autoimmune diseases: a substudy of the COVAD-2 cohort. Rheumatol Int 43, 2211–2220 (2023). https://doi.org/10.1007/s00296-023-05441-z

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