Lee Jennifer J Y, Bernatsky Sasha, Kwong Jeffrey C, Li Qing, Kwok Timothy S H, Widdifield Jessica
J.J.Y. Lee, MD, MSc, ICES, Toronto, Ontario.
S. Bernatsky, MD, PhD, Division of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec.
J Rheumatol. 2023 Oct 1. doi: 10.3899/jrheum.2023-0355.
To determine if coronavirus disease 2019 (COVID-19) vaccines were associated with adverse events of special interest (AESIs) and healthcare use among adults with rheumatoid arthritis (RA).
Among adults with RA who received at least 1 COVID-19 vaccine, a self-controlled case series (SCCS) analysis was conducted to evaluate relative incidence (RI) rates of AESIs (Bell palsy, idiopathic thrombocytopenia, acute disseminated encephalomyelitis, pericarditis/myocarditis, Guillain-Barré syndrome, transverse myelitis, myocardial infarction, anaphylaxis, stroke, deep vein thrombosis, pulmonary embolism, narcolepsy, appendicitis, and disseminated intravascular coagulation) in any 21-day period following vaccination compared to control periods. Secondary outcomes included emergency department (ED) visits, hospitalizations, and rheumatology visits. A matched non-RA comparator group was created and a separate SCCS analysis was conducted. RI ratios (RIRs) were used to compare RA and non-RA groups.
Among 123,466 patients with RA and 493,864 comparators, the majority received mRNA vaccines. For patients with RA, relative to control periods, AESIs were not increased. ED visits increased after dose 2 (RI 1.06, 95% CI 1.03-1.10) and decreased after dose 3 (RI 0.93, 95% CI 0.89-0.96). Hospitalizations were lower after the first (RI 0.83, 95% CI 0.78-0.88), second (RI 0.86, 95% CI 0.81-0.92), and third (RI 0.89, 95% CI 0.83-0.95) doses. Rheumatology visits increased after dose 1 (RI 1.08, 95% CI 1.07-1.10), and decreased after doses 2 and 3. Relative to comparators, patients with RA had a higher AESI risk after dose 3 (RIR 1.28, 95% CI 1.05-1.56). Patients with RA experienced fewer ED visits (RIR 0.73, 95% CI 0.58-0.90) and hospitalizations (RIR 0.52, 95% CI 0.36-0.75) after dose 4.
COVID-19 vaccines in patients with RA were not associated with an increase in AESI risk or healthcare use after every dose.
确定2019冠状病毒病（COVID-19）疫苗与类风湿关节炎（RA）成人患者中特殊关注的不良事件（AESIs）及医疗保健使用情况之间是否存在关联。
在接受至少一剂COVID-19疫苗的RA成人患者中，进行了一项自身对照病例系列（SCCS）分析，以评估接种疫苗后任何21天期间与对照期相比AESIs（贝尔麻痹、特发性血小板减少症、急性播散性脑脊髓炎、心包炎/心肌炎、吉兰-巴雷综合征、横贯性脊髓炎、心肌梗死、过敏反应、中风、深静脉血栓形成、肺栓塞、发作性睡病、阑尾炎和弥散性血管内凝血）的相对发病率（RI）。次要结局包括急诊就诊、住院和风湿科就诊。创建了一个匹配的非RA对照队列并进行了单独的SCCS分析。RI比率（RIRs）用于比较RA组和非RA组。
在123,466例RA患者和493,864例对照者中，大多数接受了mRNA疫苗。对于RA患者，与对照期相比，AESIs并未增加。第2剂疫苗接种后急诊就诊增加（RI 1.06，95%CI 1.03-1.10），第3剂疫苗接种后减少（RI 0.93，95%CI 0.89-0.96）。第1剂（RI 0.83，95%CI 0.78-0.88）、第2剂（RI 0.86，95%CI 0.81-0.92）和第3剂（RI 0.89，95%CI 0.83-0.95）疫苗接种后住院率较低。第1剂疫苗接种后风湿科就诊增加（RI 1.08，95%CI 1.07-1.10），第2剂和第3剂疫苗接种后减少。与对照者相比，RA患者在第3剂疫苗接种后AESIs风险更高（RIR 1.28，95%CI 1.05-1.56）。第4剂疫苗接种后，RA患者的急诊就诊（RIR 0.73，95%CI 0.58-0.90）和住院（RIR 0.52，95%CI 0.36-0.75）次数较少。
RA患者接种COVID-19疫苗后，每剂疫苗接种后AESIs风险或医疗保健使用情况均未增加。
