COVID-19 infection and hospitalisation risk according to vaccination status and DMARD treatment in patients with rheumatoid arthritis
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COVID-19 infection and hospitalisation risk according to vaccination status and DMARD treatment in patients with rheumatoid arthritis. / Cordtz, René; Kristensen, Salome; Westermann, Rasmus; Duch, Kirsten; Pearce, Fiona; Lindhardsen, Jesper; Torp-Pedersen, Christian; Andersen, Mikkel P; Dreyer, Lene.
In: Rheumatology (Oxford, England), Vol. 62, No. 1, 2023, p. 77–88.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - COVID-19 infection and hospitalisation risk according to vaccination status and DMARD treatment in patients with rheumatoid arthritis
AU - Cordtz, René
AU - Kristensen, Salome
AU - Westermann, Rasmus
AU - Duch, Kirsten
AU - Pearce, Fiona
AU - Lindhardsen, Jesper
AU - Torp-Pedersen, Christian
AU - Andersen, Mikkel P
AU - Dreyer, Lene
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
PY - 2023
Y1 - 2023
N2 - OBJECTIVES: To investigate the incidence of COVID-19 hospitalisation in unvaccinated and vaccinated patients with rheumatoid arthritis (RA) compared with matched controls, and in patients with RA according to DMARD treatment.METHODS: Danish nationwide matched cohort study from January to October 2021. Patients with RA were identified in the DANBIO register and matched 1:20 with individuals from the general population on age, sex, and vaccination status. Primary and secondary outcomes were COVID-19 hospitalisation (Danish National Patient Register) and first-time positive SARS-CoV2 PCR test (Danish COVID-19 Surveillance Register), respectively. Stratified by vaccination status, incidence rates (IRs) per 1000 person years (PY) and comorbidity-adjusted hazard ratios (aHRs) in cause-specific Cox models were calculated with 95% confidence intervals.RESULTS: In total, 28 447 unvaccinated patients and 568 940 comparators had Irs for COVID-19 hospitalisation of 10.4 (8.0-13.4) and 4.7 (4.3-5.1) per 1000 PY, respectively (aHR 1.88, 1.44-2.46). When fully vaccinated, corresponding Irs were 0.9 (0.5-1.6) and 0.5 (0.4-0.6) per 1000 PY (aHR 1.94, 1.03-3.66). Unvaccinated RA patients had an aHR of 1.22 (1.09-1.57) for testing positive for SARS-CoV2 and 1.09 (0.92-1.14) among vaccinated. Vaccinated rituximab-treated patients had increased crude IR of COVID-19 hospitalisation compared with conventional DMARD treated patients.CONCLUSION: The incidence of COVID-19 hospitalisation was increased for both unvaccinated and vaccinated patients with RA compared with controls. Importantly, the parallel decreasing risk for patients with RA suggests a comparable relative benefit of vaccination in most patients.
AB - OBJECTIVES: To investigate the incidence of COVID-19 hospitalisation in unvaccinated and vaccinated patients with rheumatoid arthritis (RA) compared with matched controls, and in patients with RA according to DMARD treatment.METHODS: Danish nationwide matched cohort study from January to October 2021. Patients with RA were identified in the DANBIO register and matched 1:20 with individuals from the general population on age, sex, and vaccination status. Primary and secondary outcomes were COVID-19 hospitalisation (Danish National Patient Register) and first-time positive SARS-CoV2 PCR test (Danish COVID-19 Surveillance Register), respectively. Stratified by vaccination status, incidence rates (IRs) per 1000 person years (PY) and comorbidity-adjusted hazard ratios (aHRs) in cause-specific Cox models were calculated with 95% confidence intervals.RESULTS: In total, 28 447 unvaccinated patients and 568 940 comparators had Irs for COVID-19 hospitalisation of 10.4 (8.0-13.4) and 4.7 (4.3-5.1) per 1000 PY, respectively (aHR 1.88, 1.44-2.46). When fully vaccinated, corresponding Irs were 0.9 (0.5-1.6) and 0.5 (0.4-0.6) per 1000 PY (aHR 1.94, 1.03-3.66). Unvaccinated RA patients had an aHR of 1.22 (1.09-1.57) for testing positive for SARS-CoV2 and 1.09 (0.92-1.14) among vaccinated. Vaccinated rituximab-treated patients had increased crude IR of COVID-19 hospitalisation compared with conventional DMARD treated patients.CONCLUSION: The incidence of COVID-19 hospitalisation was increased for both unvaccinated and vaccinated patients with RA compared with controls. Importantly, the parallel decreasing risk for patients with RA suggests a comparable relative benefit of vaccination in most patients.
U2 - 10.1093/rheumatology/keac241
DO - 10.1093/rheumatology/keac241
M3 - Journal article
C2 - 35416949
VL - 62
SP - 77
EP - 88
JO - Rheumatology
JF - Rheumatology
SN - 1462-0324
IS - 1
ER -
ID: 306519545