@article {Liewe002187, author = {Jean Liew and Milena Gianfrancesco and Carly Harrison and Zara Izadi and Stephanie Rush and Saskia Lawson-Tovey and Lindsay Jacobsohn and Clairissa Ja and Kimme L Hyrich and Laure Gossec and Anja Strangfeld and Loreto Carmona and Martin Sch{\"a}fer and Elsa Fr{\~a}zao-Mateus and Inita Bulina and Frances Stafford and Abdurrahman Tufan and Christine Graver and G{\"o}zde K{\"u}bra Yard{\i}mc{\i} and Julija Zepa and Samar Al Emadi and Claire Cook and Fatemah Abutiban and Dfiza Dey and Genevieve Katigbak and Lauren Kaufman and Emily Kowalski and Marco Ulises Mart{\'\i}nez-Mart{\'\i}nez and Naomi J Patel and Greta Reyes-Cordero and Evelyn Salido and Ellison Smith and David Snow and Jeffrey Sparks and Leanna Wise and Suleman Bhana and Monique Gore-Massy and Rebecca Grainger and Jonathan Hausmann and Emily Sirotich and Paul Sufka and Zachary Wallace and Pedro M Machado and Philip C Robinson and Jinoos Yazdany}, title = {SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry}, volume = {8}, number = {1}, elocation-id = {e002187}, year = {2022}, doi = {10.1136/rmdopen-2021-002187}, publisher = {BMJ Specialist Journals}, abstract = {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{\textquoteright} 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 ({\textpm}60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36{\textendash}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.Data are available upon reasonable request. Researchers interested in performing additional analyses from survey data are invited to submit proposals through the COVID-19 Global Rheumatology Alliance at rheum-covid.org. For approved projects, we will be able to provide summary tables and data analyses as requested. We do not currently have IRB approval to make the raw data available to other researchers.}, URL = {https://rmdopen.bmj.com/content/8/1/e002187}, eprint = {https://rmdopen.bmj.com/content/8/1/e002187.full.pdf}, journal = {RMD Open} }