PT  - JOURNAL ARTICLE
AU  - Claire Cook
AU  - Naomi J.  Patel
AU  - Xiaoqing Fu
AU  - Xiaosong Wang
AU  - Yumeko Kawano
AU  - Kathleen M.M.  Vanni
AU  - Grace Qian
AU  - Emily Banasiak
AU  - Emily Kowalski
AU  - Hyon K.  Choi
AU  - Yuqing Zhang
AU  - Jeffrey A.  Sparks
AU  - Zachary S.  Wallace
TI  - Comparative effectiveness of BNT162b2 and mRNA-1273 vaccines against COVID-19 infection among patients with systemic autoimmune rheumatic diseases on immunomodulatory medications
AID  - 10.3899/jrheum.220870
DP  - 2023 Jan 15
TA  - The Journal of Rheumatology
PG  - jrheum.220870
4099  - http://www.jrheum.org/content/early/2023/01/10/jrheum.220870.short
4100  - http://www.jrheum.org/content/early/2023/01/10/jrheum.220870.full
AB  - Objective To compare the effectiveness of mRNA vaccines (BNT162b2 vs mRNA-1273) against COVID-19 infection among patients with systemic autoimmune rheumatic diseases (SARDs) on immunomodulatory medications. Methods We identified patients with SARDs being treated with DMARDs and/or glucocorticoids in the Mass General Brigham healthcare system who received either BNT162b2 or mRNA-1273 as their initial vaccine series. Patients were followed until positive SARS-CoV-2 test, death, or 2/22/2022. We compared the risk of breakthrough infection between BNT162b2 and mRNA-1273 vaccine recipients using time stratified, overlap propensity score–weighted Cox proportional hazard models. Results We identified 9838 patients with SARDs who received BNT162b2 or mRNA-1273. Demographic and clinical characteristics were similar in both groups after overlap weighting: mean age 61 years, 75% female, 54% with rheumatoid arthritis, and 74% receiving conventional and 43% receiving biologic DMARDs. Of 5516 BNT162b2 and 4322 mRNA-1273 recipients, 446 and 329 had a breakthrough infection, respectively. The corresponding time-stratified PS weighted rate difference of breakthrough infection was 0.71 (95%CI: -0.70, 2.12) per 1000 person months with a weighted HR of 1.12 (95%CI: 0.90, 1.39). When follow-up was censored prior to the Omicron wave, there was a trend towards higher breakthrough risk with BNT162b2 vs mRNA-1273 (weighted HR 1.34, 95%CI: 0.91, 1.98). Conclusion Among SARD patients, the risk of breakthrough COVID-19 infection is similar after receiving either BNT162b2 or mRNA-1273. Patients with SARDs initiating the vaccine series should be encouraged to receive whichever mRNA vaccine is available.