RT Journal Article
SR Electronic
T1 Comparative effectiveness of BNT162b2 and mRNA-1273 vaccines against COVID-19 infection among patients with systemic autoimmune rheumatic diseases on immunomodulatory medications
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.220870
DO 10.3899/jrheum.220870
A1 Claire Cook
A1 Naomi J.  Patel
A1 Xiaoqing Fu
A1 Xiaosong Wang
A1 Yumeko Kawano
A1 Kathleen M.M.  Vanni
A1 Grace Qian
A1 Emily Banasiak
A1 Emily Kowalski
A1 Hyon K.  Choi
A1 Yuqing Zhang
A1 Jeffrey A.  Sparks
A1 Zachary S.  Wallace
YR 2023
UL http://www.jrheum.org/content/early/2023/01/10/jrheum.220870.abstract
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.