key: cord-0743845-fqo96psp
authors: Ledbetter, Stephanie S.; Xie, Fenglong; Stewart, Patrick; Cutter, Gary; George, Michael; Saag, Kenneth G.; Nowell, William Benjamin; Mikuls, Ted; Jackson, Lesley; Danila, Maria I.; Winthrop, Kevin; Curtis, Jeffrey R.
title: COVID‐19 Vaccine Uptake and Vaccine Hesitancy in Rheumatology Patients Receiving Immunomodulatory Therapies Treated In Community Practice Settings
date: 2022-01-19
journal: Arthritis Rheumatol
DOI: 10.1002/art.42067
sha: 7f3d96cad9f5d6108522a7e6c602032568ba4570
doc_id: 743845
cord_uid: fqo96psp

nan

Patients with autoimmune and inflammatory rheumatic diseases (AIIRD) may be more likely to contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and have greater morbidity and mortality from COVID-19. Recognizing these risks, the American College of Rheumatology (ACR) published its recent "Guidance for COVID-19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases" recommending vaccination and supplemental (booster) dosing (1). However, patients with AIIRD may exhibit vaccine hesitancy for a variety of reasons including fear of side effects (e.g., disease flare, new-onset autoimmune manifestations) (2) (3) or uncertainty regarding vaccination benefits given the attenuating effects of immune modulatory therapy on vaccine response. As part of its research agenda, the ACR Task Force recommended to "Optimize approaches to address vaccine hesitancy for high-risk AIIRDs patients who are reticent or unwilling to undergo vaccination, with particular attention to vulnerable populations." (1) Given uncertainties regarding the scale of vaccine hesitancy in rheumatology patients, we analyzed data collected for ascertaining SARS-CoV-2 vaccine uptake in a large community practice-based rheumatology research network (Bendcare). The tablet-based, electronic survey was conducted at 101 rheumatology provider's offices from June to September 2021 and collected patients' self-reported vaccination status, and for those not vaccinated, their intent to be vaccinated in the future. The approximately 3-item (depending on responses and branching logic), uncompensated survey was implemented was part of routine care, had a 98% completion rate (number of patients finishing the survey divided by number of patients starting the survey), and was linked back to electronic health record data in the network's data repository ('Columbus'). We used descriptive statistics to evaluate vaccination status by AIIRD condition and multivariable logistic regression to model the association between having an AIIRD condition and vaccine receipt, controlling for age, sex, and race/ethnicity. In all, 58,529 patients provided complete data, of whom 20,987 had an AIIRD and were currently receiving targeted therapies including biologics or janus kinase inhibitors. As of September 9, 2021, 77.0% (n=43,675) patients had been vaccinated, 16.9% were not vaccinated and did not plan to be, and 6.1% were not vaccinated but still planned to be.

AIIRD patients were significantly less likely to have been vaccinated (76.9%) vs comparator patients (i.e., osteoarthritis or osteoporosis, receiving no DMARD), 87.0%, p< 0.0001, Figure) . After controlling for age, sex, and race/ethnicity, AIIRD individuals were less likely to be vaccinated (OR=0.84, 95% CI 0.77-0.92, p < .001) vs comparator patients.

Older individuals (OR=1.49 per 10 years) and Asians (OR=2.42, 95% CI 1.77-3.33) were more likely to be vaccinated; slightly lower rates of vaccination in Black (OR=0.92, 95% CI 0.8-1.04) and Hispanic patients (OR=0.95, 95% CI 0.85-1.06) were not statistically significant.

As anticipated by the ACR Task Force, these findings indicate that vaccine hesitancy remains an important and persistent problem despite the wide availability of the COVID-19 vaccine. Fortunately, increasing data suggests that healthcare professional recommendations may increase patient willingness and intention to receive the vaccine (3). Providers should make specific efforts for at-risk immunocompromised AIIRD patients to both ascertain vaccine status and recommend vaccination and supplemental dosing absent contraindications. 

American College of rheumatology guidance for COVID-19 vaccination in patients with rheumatic and musculoskeletal diseases: version 2

COVID-19 vaccine hesitancy in patients with systemic autoimmune rheumatic disease: an interview-based survey

Vaccination against COVID-19: Expectations and concerns of patients with autoimmune and rheumatic diseases