SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: Results from the COVID-19 Global Rheumatology Alliance provider registry

Jean Liew (Coresponding Author), Milena Gianfrancesco, Carly Harrison, Zara Izadi, Stephanie Rush, Saskia Lawson-Tovey, Lindsay Jacobsohn, Clairissa Ja, Kimme L. Hyrich, Laure Gossec, Anja Strangfeld, Loreto Carmona, Martin Schafer, Elsa Frazao-Mateus, Inita Bulina, Frances Stafford, Abdurrahman Tufan, Christine Graver, Gozde Kubra Yardlmcl, Julija ZepaSamar Al Emadi, Claire Cook, Fatemah Abutiban, Dfiza Dey, Genevieve Katigbak, Lauren Kaufman, Emily Kowalski, Marco Ulises Martinez-Martinez, Naomi J. Patel, Greta Reyes-Cordero, Evelyn Salido, Ellison Smith, David Snow, Jeffrey Sparks, Leanna Wise, Suleman Bhana, Monique Gore-Massy, Rebecca Grainger, Jonathan Hausmann, Emily Sirotich, Paul Sufka, Zachary Wallace, Pedro M. Machado, Philip C. Robinson, Jinoos Yazdany

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)
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Objective. While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2. 

Methods. We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes. Results SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died.

Conclusion. More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.

Original languageEnglish
Article numbere002187
JournalRMD Open
Issue number1
Publication statusPublished - 6 Apr 2022
Externally publishedYes


  • antirheumatic agents
  • COVID-19
  • vaccination

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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