Vaccination Cut Long COVID Risk for Rheum Patients Save

Patients with rheumatologic conditions who developed breakthrough COVID-19 infection after vaccination were less likely to suffer long-term symptoms than unvaccinated but otherwise similar patients, researchers said.

Among 280 rheumatic disease patients (most with some form of autoimmune arthritis or connective tissue disease) who survived acute COVID-19, 21% of those vaccinated against the condition experienced symptoms lasting 90 days or more after the acute phase, compared with 41% of unvaccinated patients, according to Naomi Patel, MD, of Massachusetts General Hospital in Boston, and colleagues.

When the data were adjusted for age, sex, race, comorbidities, and use of immunosuppressant drugs, the odds that a vaccinated patient would develop post-acute COVID symptoms, also called "long COVID," through day 90 were just one-tenth that of unvaccinated patients (adjusted OR 0.10, 95% CI 0.04-0.22), the researchers wrote in a preprint manuscript appearing on the medRxiv site.

Rates of post-acute symptoms lasting 28 days were also lower for the vaccinated patients: 41% versus 54% (P=0.04), with an adjusted odds ratio of 0.49 (95% CI 0.29-0.83).

"These findings suggest that despite a higher risk of breakthrough infection, vaccination in patients with SARDs [systemic autoimmune rheumatic diseases] not only reduces the risk of severe acute outcomes but also long-term outcomes," Patel and colleagues wrote.

But the group also cautioned that vaccination is not a panacea for these patients. Incidence of post-acute symptoms, they wrote, "remains common among SARD patients, even after vaccination, and when present, the severity is similar to those who were either unvaccinated or partially vaccinated."

The 280 patients in the study were all treated for COVID-19 from March 2020 to July 2022 in Boston's Mass General Brigham system, whose medical records included billing codes for rheumatic diseases. When contacted after recovering from the acute infection, they had agreed to participate in a long-term follow-up study, which included questionnaires on various aspects of their health. This study commenced in March 2021.

Just under 60% of the overall group had autoimmune arthritis diagnoses, 24% had autoimmune connective tissue diseases, and 9% had some type of vasculitis. These diagnoses were well balanced between the vaccinated (n=116) and unvaccinated (n=164) cohorts.

There were, however, some important differences between groups. More in the vaccinated cohort were using disease-modifying antirheumatic drugs (DMARDs) such methotrexate, mycophenolate mofetil, antimalarials, and biologic agents. Obesity was significantly more prevalent among the unvaccinated patients.

As is typical in systemic autoimmune disease, 80% of both groups were women. Mean age was 52 years, and more than 80% were white.

About half of the unvaccinated group had COVID-19 prior to February 2021, when vaccines first became widely available. After that, most of the infections occurred in vaccinated patients (100 vs 14). Only 4% of the vaccinated group required hospitalization versus 16% of the unvaccinated (hence the authors' comment about the reduced risk of severe acute outcomes).

All 280 supplied follow-up data for the first 28 days after recovery from the acute phase; data covering 90 days and beyond were available for 47 in the vaccinated group and 159 in the unvaccinated.

Post-acute symptoms included pain, fatigue, and functional difficulties. At the time of questionnaire completion (up to 204 days after the acute phase), median pain scores on the Short-Form McGill Pain instrument were 4 in the vaccinated group versus 5 for the unvaccinated (P=0.04). Median scores from the Fatigue Symptom Inventory were 48 in the vaccinated and 55 in the unvaccinated (P=0.08). Median functional ability scores on the modified Health Assessment Questionnaire were 0.1 for both groups, and overall health status self-ratings were also similar.

Participants were also asked to record days with and without symptoms, and these differed significantly between the groups. In total, vaccinated patients rated themselves symptom-free during follow-up for an average 138 days, compared with 109 days among the unvaccinated -- a difference of nearly 1 month.

Limitations to the study included its reliance on participants' self-reports, differences in the predominant circulating virus variants over time and in the acute-phase treatments used, and possible conflation of SARD symptoms with those of post-acute COVID. As well, the report appeared as a preprint manuscript and therefore had not undergone peer review.