Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.
Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
Rheumatology (Oxford). 2023 Apr 3;62(4):1445-1450. doi: 10.1093/rheumatology/keac484.
To investigate the association between vaccination against coronavirus disease 2019 (COVID-19) and autoimmune rheumatic disease (AIRD) flare.
Patients with AIRDs vaccinated against COVID-19 who consulted for disease flare between 1 December 2020 and 31 December 2021 were ascertained in Clinical Practice Research Datalink (Aurum). AIRD flare was defined as consultation for AIRD with CS prescription on the same day or the next day. Vaccination was defined using date of vaccination and product code. The observation period was partitioned into vaccine-exposed (21 days after vaccination), pre-vaccination (7 days before vaccination) and remaining vaccine-unexposed periods. Participants contributed data with multiple vaccinations and outcomes. Season adjusted incidence rate ratios (aIRR) and 95% CI were calculated using self-controlled case series analysis.
Data for 3554 AIRD cases, 72% female, mean age 65 years and 68.3% with RA, were included. COVID-19 vaccination was associated with significantly fewer AIRD flares in the 21-day vaccine-exposed period when all vaccinations were considered [aIRR (95% CI) 0.89 (0.80, 0.98)]. Using dose-stratified analyses there was a statistically significant negative association in the 21 days after first COVID-19 vaccination but no association after the second or third COVID-19 vaccinations [aIRR (95% CI) 0.76 (0.66, 0.89), 0.94 (0.79, 1.11) and 1.01 (0.85, 1.20), respectively]. On AIRD-type stratified analyses, vaccination was not associated with disease flares. Vaccination without or after severe acute respiratory syndrome coronavirus 2 infection, and with vectored DNA or mRNA vaccines, associated with comparable reduced risk of AIRD flares in the vaccine-exposed period after first COVID-19 vaccination.
Vaccination against COVID-19 was not associated with increased AIRD flares regardless of prior COVID-19, AIRD type, and whether mRNA or DNA vaccination technology were used.
研究接种 2019 年冠状病毒病（COVID-19）疫苗与自身免疫性风湿病（AIRD）发作之间的关联。
在 Aurum 的临床实践研究数据库（Clinical Practice Research Datalink）中确定了 2020 年 12 月 1 日至 2021 年 12 月 31 日期间因 AIRD 发作而就诊的接种 COVID-19 疫苗的 AIRD 患者。AIRD 发作定义为同一天或次日因 AIRD 就诊并开具 CS 处方。疫苗接种使用接种日期和产品代码定义。观察期分为疫苗接种后 21 天（疫苗暴露期）、疫苗接种前 7 天（疫苗前暴露期）和剩余疫苗未暴露期。参与者提供了多次接种和结果的数据。使用自对照病例系列分析计算季节调整发病率比（aIRR）和 95%CI。
纳入了 3554 例 AIRD 病例的数据，其中 72%为女性，平均年龄为 65 岁，68.3%为类风湿关节炎患者。当考虑所有疫苗接种时，COVID-19 疫苗接种与 21 天疫苗暴露期内 AIRD 发作明显减少相关[aIRR（95%CI）0.89（0.80，0.98)]。使用剂量分层分析，首次 COVID-19 疫苗接种后 21 天存在统计学上显著的负相关，但第二次或第三次 COVID-19 疫苗接种后无关联[aIRR（95%CI）0.76（0.66，0.89）、0.94（0.79，1.11）和 1.01（0.85，1.20）]。在 AIRD 型分层分析中，疫苗接种与疾病发作无关。首次 COVID-19 疫苗接种后疫苗暴露期内，无论是否有严重急性呼吸综合征冠状病毒 2 感染、是否使用载体 DNA 或 mRNA 疫苗接种，与 AIRD 发作风险降低相关。
无论先前是否感染过 COVID-19、AIRD 类型以及使用的是 mRNA 还是 DNA 疫苗技术，接种 COVID-19 疫苗与 AIRD 发作增加无关。
