Fourth Dose of COVID Vaccine Boosts Protection in Patients with Rheumatic Disease

Patients with autoimmune rheumatic diseases, which include rheumatoid arthritis and other chronic disorders that cause inflammation, are at increased risk of SARS-CoV-2 infection, as well as death due to severe COVID-19. Many patients receive disease-modifying antirheumatic drugs (DMARDs) to treat these conditions, but this treatment has been associated with a blunted response to COVID-19 vaccines. The U.S. Centers for Disease Control and Prevention recommends that patients receiving DMARDs receive a fourth dose of the mRNA vaccine in addition to the three-dose primary series to protect against COVID-19. A new study led by Mass General Brigham researchers suggests that this recommendation saved lives and reduced hospitalizations among patients in this high-risk group. Results are published in The Lancet Rheumatology.

To conduct their study, the researchers used observational data from the Mass General Brigham healthcare system to compare rheumatic disease patients taking DMARDs who received a fourth dose of the mRNA vaccine to those who did not. The study included data from 4,305 patients. They found that patients who received the fourth dose had a 41 percent reduction in risk for infection and 65 percent reduction for hospital admission/death compared to those who did not.

“A fourth dose of COVID-19 mRNA vaccine provides considerable protection against any SARS-CoV-2 infection and severe COVID-19 among patients with systemic autoimmune rheumatic diseases using DMARDs,” said co-corresponding author Zachary Wallace, MD, MSc, of the Division of Rheumatology, Immunology and Allergy at Massachusetts General Hospital (MGH). “These patients should be encouraged to stay up-to-date with COVID-19 mRNA vaccines, including boosters after the primary vaccination series.”

Since the beginning of the pandemic, researchers from across Brigham and Women’s Hospital (BWH) and MGH, both founding members of the Mass General Brigham health care system, have been working together to give special attention to this group of patients to find insights that could help inform their treatment as well as the care of broader patient populations.

“At the very beginning of the pandemic, we joined forces to identify every rheumatic disease patient with COVID seen at our institutions so that we could follow their clinical course and collect survey and blood data,” said co-corresponding author Jeffrey Sparks, MD, MMSc, of the Division of Rheumatology, Inflammation, and Immunity at BWH. “Working together, we are finding important clues that could help better protect patients from infection and severe disease.”

Authorship: Additional Mass General Brigham authors include Jennifer S Hanberg (BWH), Xiaoqing Fu (BWH, MGH), Xiaosong Wang (BWH), Naomi J Patel (BWH, MGH), Yumeko Kawano (BWH, MGH), Abigail Schiff (BWH), Emily N Kowalski (BWH), Claire E Cook (MGH), Kathleen M M Vanni (BWH), Krishan Guzzo (MGH), Grace Qian (BWH), Katarina J Bade (BWH), Alene Saavedra (BWH), Rathnam Venkat (BWH), Shruthi Srivatsan (MGH), and Yuqing Zhang (MGH).

Disclosures: NJP reports consulting fees from FVC Health and Alosa Health. JAS reports grant funding from Bristol Myers Squibb, the National Institute of Arthritis and Musculoskeletal and Skin Disease, the R Bruce and Joan M Mickey Research Scholar Fund, and the Llura Gund Award for Rheumatoid Arthritis Care and Research; and consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Janssen, Optum, Pfizer, ReCor, and Inova Diagnostics. ZSW reports funding from the National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Disease for the present manuscript; grants or contracts from Bristol Myers Squibb and Principia/Sanofi; consulting fees from Viela Bio, Zenas BioPharma, BioCryst, Horizon, Sanofi, and Medpace; and advisory board participation for Sanofi, Novartis, Shionogi, Otsuka/Visterra, and Horizon.

Funding: The National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases

Paper cited: Hanberg JS et al. “Effectiveness of a fourth dose of COVID-19 mRNA vaccine in patients with systemic autoimmune rheumatic diseases using disease-modifying antirheumatic drugs: an emulated target trial” Lancet Rheumatology DOI: 10.1016/S2665-9913