Patients with autoimmune rheumatic diseases benefit significantly from the fourth dose of COVID-19 vaccine

Patients with autoimmune rheumatic diseases, including rheumatoid arthritis and other chronic conditions that cause inflammation, are at increased risk for SARS-CoV-2 infection and death from 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 primary three-dose series to protect against COVID-19. A new study led by researchers at Mass General Brigham suggests that this recommendation saved lives and reduced hospitalizations among patients in this risk group. Results are published in The Lancet Rheumatology.

To conduct their study, the researchers used observational data from Mass General Brigham’s health care system to compare rheumatic patients who took DMARDs and received a fourth dose of the mRNA vaccine with 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 of infection and a 65 percent reduction in admission/death compared to those who did not.

A fourth dose of COVID-19 mRNA vaccine provides significant protection against any SARS-CoV-2 infection and severe COVID-19 in patients with systemic autoimmune rheumatic diseases taking DMARDs. These patients should be encouraged to remain current on COVID-19 mRNA vaccines, including boosters after the primary vaccination series.”

Zachary Wallace, MD, MSc, co-corresponding author of the Division of Rheumatology, Immunology and Allergy at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham health care system

Since the start of the pandemic, researchers from across Brigham and Women’s Hospital (BWH) and MGH have been working together to pay special attention to this group of patients to uncover insights that can help inform their treatment and the care of broader patient populations. .

“At the very beginning of the pandemic, we joined forces to identify every rheumatic patient with COVID we see in our institutions so we could monitor their clinical course and collect examination and blood data,” said co-corresponding author Jeffrey Sparks, MD, MMSc, ​​of the Division of Rheumatology, Inflammation and Immunity at BWH. “Working together, we will find important clues that can help better protect patients against infections and serious diseases.”