Incidence of Vaccine Adverse Events in Autoimmune Disease Patients

October 14, 2021

A comment piece published in The Lancet Rheumatology examined the results of a questionnaire assessing adverse events in those with autoimmune disease (AD) following their first COVID-19 vaccination. Participants were asked (but not obligated) to recruit a “healthy” control of similar age and sex. They were asked whether they had 1) received a COVID-19 vaccine 2) if so, whether they experienced any local or systemic adverse events in the 7 days following vaccination 3) if so, to report the severity and duration of such adverse events. Patients were also asked to monitor any changes in their autoimmune disease for up to two months post-vaccination.

Questionnaires from 505 patients (including 204 with rheumatoid arthritis and 81 with multiple sclerosis) and 203 controls were included for analysis. 328 of 505 patients were on immunosuppressive medications at the time of the questionnaire, most commonly anti-CD20 and TNF-inhibitors. AstraZeneca and Pfizer were the most common vaccines administered to both patients and controls; less than 20% of both AD and healthy participants were given the Moderna vaccine.

51% of patients and 52% of controls reported at least one mild adverse event post-vaccination. 21% and 19%, respectively, reported moderate adverse events. 1% of AD patients experienced severe adverse events. The most common adverse event reported was pain at the injection site. “Joint complaints were reported more frequently by patients with rheumatic diseases than controls (49 [10%] vs 3 [1%]), but only a small proportion of patients (26 [5%]) reported a deterioration of their autoimmune disease up to 2 months after COVID-19 vaccination.” The AstraZeneca vaccine in females less than 55 years of age were “independently associated with an increased likelihood” of reporting an adverse event.

Overall, analysis of the data showed that adverse events to the COVID-19 vaccine were similar for both AD patients and healthy controls. “The observed adverse events consisted of expected transient local or systemic reactions that were mostly self-limiting.” Moreover, COVID-19 vaccinations did not seem to trigger AD flares.