Infectious Disease

Four COVID vaccine doses superior to three in patients with autoimmune rheumatic disease

March 28, 2023

2 min read

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Patients with autoimmune rheumatic disease who receive a fourth dose of the Pfizer mRNA COVID-19 vaccine appear to be better protected than patients who receive three doses, according to data published in Rheumatology.

“Currently, there are six SARS-CoV-2 vaccines commercially approved globally, and all are highly effective in preventing symptomatic COVID-19 infection, complications, and mortality in the general population,” Amir Bieber, MD, of the rheumatic diseases unit at Emek Medical Center, in Afula, Israel, and colleagues wrote. “However, the emergence of new SARS-CoV-2 variant strains and the waning immunogenicity of second and third doses raised concerns regarding the long-term effectiveness of the SARS-CoV-2 vaccine.”

Data

Patients with autoimmune rheumatic disease who receive a fourth dose of the Pfizer mRNA COVID-19 vaccine appear to be better protected than patients who receive three doses, according to data derived from Bieber A, et al. rheumatology. 2023;doi:10.1093/rheumatology/kead064.

To investigate the effectiveness of a fourth dose of the BNT162b2 (Pfizer/BioNTech) mRNA vaccine in patients with autoimmune and rheumatic diseases, Bieber and colleagues conducted a retrospective study of patients enrolled in the Clalit Health Services system in Israel. The researchers analyzed data from every enrolled adult aged 18 years or older with an autoimmune disease, and without a prior recorded COVID-19 infection, who received at least three doses of the Pfizer/BioNTech vaccine and was eligible for a fourth. Included autoimmune rheumatic diseases were rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus and systemic sclerosis.

The study period spanned from Jan. 16 through March 31, 2022. Patients included were classified as having received either three doses, consisting of the initial two-dose series and a booster, or four doses of the vaccine. The primary outcome was the diagnosis of COVID-19 during the study period. Secondary outcomes included hospitalization and death related to COVID-19.

The analysis included a total of 43,748 patients. Among these patients, 27,766 were in the three-dose control group while 15,982 had received four doses. COVID-19 infection occurred in 25% of patients in the three-dose group, compared with 11% in the four-dose cohort. Overall, patients who received four doses demonstrated a lower risk for developing COVID-19 (HR = 0.54; 95% CI, 0.52-0.58) vs. patients who received three doses, according to the researchers.

“We found that the fourth dose of the BNT162b2 vaccine was associated with a lower COVID-19 infection rate among [autoimmune rheumatic disease (ARD)] patients,” Bieber and colleagues wrote. “In addition, patients who were vaccinated with the fourth dose had a lower risk for COVID-19-related hospitalization and mortality. Furthermore, our results remained consistent regardless of the type of background ARD diagnosis, medical background or treatment.”

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COVID-19 and Rheumatology

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