ArticleClinical rheumatology2026
COVID-19 outcomes among vaccinated and unvaccinated patients receiving disease-modifying antirheumatic drugs and biologic therapies: a retrospective multihospital cohort study.
Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
INTRODUCTION/
objectivesPatients receiving disease-modifying antirheumatic drugs (DMARDs) and biologic therapies were underrepresented in initial COVID-19 vaccine trials, limiting understanding of vaccine effectiveness in immunosuppressed populations. While immunogenicity studies demonstrate reduced antibody, real-world outcome-based evidence remains limited. We evaluated the association between COVID-19 vaccination and clinical outcomes among hospitalized patients receiving systemic DMARDs and biologic therapies.
methodsWe conducted a retrospective cohort study across seven hospitals within the UPMC health system in Central Pennsylvania. Adults (≥ 18 years) hospitalized with COVID-19 between March 2020 and April 2025 and receiving immunomodulatory therapy. Vaccination status was determined using electronic health records and registry-linked coding data, with vaccine type and SARS-CoV-2 variants also assessed. The primary outcome was hospital length of stay (LOS). The secondary outcome was in-hospital mortality. Multivariable logistic regression and gamma regression models adjusted for key demographic and clinical covariates.
resultsAmong 254 patients, 144 were vaccinated and 110 were unvaccinated. One hundred twenty-eight vaccinated patients received at least one booster. Vaccinated had shorter median LOS (6 vs. 10 days; p < 0.0001), with a 37% reduction in LOS odds. Among vaccinated, those who received at least 1 booster had shorter LOS than those without a booster (6 vs. 7.5 days; p = 0.0414). In-hospital mortality was lower among vaccinated (6.25% vs. 27.27%; p < 0.0001), with an 84% reduction in odds of death (adjusted OR, 0.157; 95% CI, 0.068-0.361).
conclusionAmong hospitalized receiving DMARDs and biologic therapies, COVID-19 vaccination was independently associated with reduced mortality and shorter hospital length of stay, supporting vaccination as a critical protective strategy in immunosuppressed populations. Key Points • COVID-19 vaccination was independently associated with a 37% reduction in hospital length of stay among immunosuppressed patients receiving DMARDs or biologics. • Vaccinated patients experienced substantially lower in-hospital mortality (6.25% vs 27.27%), even after adjustment for clinical covariates. • Vaccination was associated with an 87% reduction in adjusted odds of death. • Findings support COVID-19 vaccination as protective in patients receiving DMARDs and biologic therapies.
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