Evidence map›Paper›PMID 37873462›Full record

ArticlemedRxiv : the preprint server for health sciences2023

Immunomodulators and risk for breakthrough infection after third COVID-19 mRNA vaccine among patients with rheumatoid arthritis: A cohort study.

Abigail E Schiff, Xiaosong Wang, Naomi J Patel, Yumeko Kawano, Emily N Kowalski, Claire E Cook, Kathleen M M Vanni, Grace Qian, Katarina J Bade, Alene A Saavedra and 5 more

Open access · greenAbstract readPreprint
PubMed Full text at PMC Publisher
In one paragraph

Article in medRxiv : the preprint server for health sciences, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 4 institutions in 1 country.

Abigail E SchiffDepartment of Medicine, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Xiaosong Wangivision of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Naomi J PatelDivision of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114).
Yumeko Kawanoivision of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Emily N Kowalskiivision of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Claire E CookDivision of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114).
Kathleen M M Vanniivision of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Grace Qianivision of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Katarina J Badeivision of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Alene A Saavedraivision of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Shruthi SrivatsanDivision of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114).
Zachary K WilliamsDivision of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114).
Rathnam K VenkatTufts University School of Medicine, Boston, MA, USA (145 Harrison Ave, Boston, MA 02111).
Zachary S WallaceDivision of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114).
Jeffrey A Sparksivision of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115).
Brigham and Women's Hospital · USMassachusetts General Hospital · USHarvard University · USTufts University · US

Funding

VERITY: Value and Evidence in Rheumatology using bioInformaTics, and advanced analYticsP30AR072577 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI Daniel Hal Solomon · 2017 to 2026
$9.8M
Joint Biology Consortium Resource-based CenterP30AR070253 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI Peter A Nigrovic, Jeffrey Andrew Sparks · 2016 to 2026
$9.4M
Rheumatoid Arthritis-Related Autoantibodies, Articular Inflammation, and RA-Associated Interstitial Lung DiseaseR01AR077607 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI SPARKS, JEFFREY ANDREW · 2021 to 2025
$3.7M
Immunologic and Clinical Sequelae after COVID-19 in Patients with Systemic Autoimmune Rheumatic DiseasesR01AR080659 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI Jeffrey Andrew Sparks · 2023 to 2026
$2.9M
Impact of ANCA Type and Rituximab vs. Cyclophosphamide on Cardiovascular Risk, Mortality, and Quality-Adjusted Life Years inANCA-Associated VasculitisK23AR073334 · NIAMS · MASSACHUSETTS GENERAL HOSPITAL · PI WALLACE, ZACHARY SCOTT · 2018 to 2022
$948k
Personalizing AAV Management by Leveraging Big Data: Targeting Complication ClustersR03AR078938 · NIAMS · MASSACHUSETTS GENERAL HOSPITAL · PI WALLACE, ZACHARY SCOTT · 2021 to 2022
$189k
NIAMS NIH HHS K23 AR073334NIAMS NIH HHS P30 AR070253NIAMS NIH HHS P30 AR072577NIAMS NIH HHS R01 AR077607NIAMS NIH HHS R01 AR080659NIAMS NIH HHS R03 AR078938
6 · The paper itself

Abstract

Objectives: To investigate COVID-19 breakthrough infection after third mRNA vaccine dose among patients with RA by immunomodulator drug class, and we hypothesized that CD20 inhibitors (CD20i) would have higher risk for breakthrough COVID-19 vs. TNF inhibitors (TNFi). Methods: We performed a retrospective cohort study investigating breakthrough COVID-19 among RA patients at Mass General Brigham in Boston, MA, USA. Patients were followed from the date of 3rd vaccine dose until breakthrough COVID-19, death, or end of follow-up (18/Jan/2023). Covariates included demographics, lifestyle, comorbidities, and prior COVID-19. We used Cox proportional hazards models to estimate breakthrough COVID-19 risk by immunomodulator drug class. We used propensity score (PS) overlap-weighting to compare users of CD20i vs. TNFi. Results: We analyzed 5781 patients with RA that received 3 mRNA vaccine doses (78.8% female, mean age 64.2 years). During mean follow-up of 12.8 months, 1173 (20.2%) had breakthrough COVID_19. Use of CD20i (adjusted HR 1.74, 95%CI 1.30-2.33) and glucocorticoid monotherapy (adjusted HR 1.47, 95%CI 1.09-1.98) were each associated with breakthrough COVID-19 compared to TNFi use. In the PS overlap-weighted analysis, CD20i users also had higher breakthrough COVID-19 risk than TNFi users (HR 1.62, 95%CI 1.02-2.56). A sensitivity analysis excluding patients with cancer or interstitial lung disease yielded similar findings. Conclusions: We identified CD20i and glucocorticoid monotherapy as risk factors for breakthrough COVID-19 among patients with RA after a 3rd vaccine dose. This contemporary study highlights the real-world impact of blunted immune responses in these subgroups and the need for effective risk mitigation strategies.

Indexed as

COVID-19epidemiologyimmunosuppressionreinfection

Identifiers

PMID37873462
PMCPMC10592996
OpenAlexW4387448817

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.