Article Text

Download PDFPDF

LO-019 Breakthrough SARS-CoV-2 infection in fully vaccinated patients with systemic lupus erythematosus: results from the COVID-19 vaccination in autoimmune disease (COVAD) study
  1. Emelie Khilgren Olsson1,
  2. R Naveen2,
  3. Elena Nikiphorou3,4,
  4. Julius Lindblom1,
  5. Sreoshy Saha5,
  6. Syahrul Sazliyana Shaharir6,
  7. Wanruchada Katchamart7,
  8. Phonpen Akarawatcharangura Goo8,
  9. Lisa Traboco9,
  10. Yi-Ming Chen10,11,
  11. Kshitij Jagtap12,
  12. James Lilleker13,14,
  13. Arvind Nune15,
  14. John Pauling16,17,
  15. Chris Wincup18,19,
  16. Vishwesh Agarwal20,
  17. Dey Dzifa21,
  18. Carlos Enrique Toro Gutierrez22,
  19. Carlo Vinicio Caballero23,
  20. Hector Chinoy13,24,25,
  21. Vikas Agarwal2,
  22. Rohit Aggarwal26,
  23. Latika Gupta2,27,28 and
  24. Ioannis Parodis1,29
  1. 1Department of medicine Solna, Karolinska Institutet, Sweden
  2. 2Department of Clinical Immunology and Rheu, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India
  3. 3Centre for Rheumatic Diseases, King’s College London, UK
  4. 4Rheumatology Department, King’s College Hospital, UK
  5. 5Mymensingh Medical College, Mymensingh Medical College, Bangladesh
  6. 6Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia
  7. 7Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
  8. 8Department of Medicine, Queen Savang Vadhana Memorial Hospital, Thailand
  9. 9Department of Medicine, Section of Rheumatology, St. Luke’s Medical Center-Global City, Philippines
  10. 10Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan
  11. 11Department of Medical Research, Taichung Veterans General Hospital, Taiwan
  12. 12Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, India
  13. 13Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, Schoo, The University of Manchester, UK
  14. 14Salford Royal NHS Foundation Trust, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Centre for Clinical Neurosciences, UK
  15. 15Southport and Ormskirk Hospital NHS Trust, Southport and Ormskirk Hospital NHS Trust, Southport and Ormskirk Hospital NHS Trust, Southport and Ormskirk Hospital NHS Trust, UK
  16. 16Bristol Medical School Translational Health Sciences, Bristol Medical School Translational Health Sciences, UK
  17. 17Department of Rheumatology, North Bristol NHS Trust, UK
  18. 18Department of Rheumatology, Division of Medicine, Rayne Institute, University College London, UK
  19. 19Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH, GOSH, Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH, GOSH, UK
  20. 20Mahatma Gandhi Mission Medical College, Mahatma Gandhi Mission Medical College, India
  21. 21Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Korle-Bu, Ghana
  22. 22General Director, Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontificia Universidad Javeriana Cali, Colombia
  23. 23Department of Medicine, Barranquilla, Atlantico, Hospital Universidad del Norte, Colombia
  24. 24National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, UK
  25. 25Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, UK
  26. 26Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, UK
  27. 27Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, UK
  28. 28Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, UK
  29. 29Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Sweden


Background Although many studies have been conducted within COVID-19, there are still unanswered questions regarding breakthrough infections (BTIs), particularly in patients with systemic lupus erythematosus (SLE). We aimed to determine the occurrence of breakthrough COVID-19 infections in patients with SLE versus other autoimmune rheumatic diseases (AIRDs), non-rheumatic autoimmune diseases (nrAIDs), and healthy controls (HCs).

Methods The study was based on data from the COVAD questionnaire which amassed a total of 10,783 complete responses from patients with SLE, AIRD, or nrAIRD, and HCs. After exclusion of individuals who were unvaccinated, those who received one vaccine dose only, and those with uncertain responses regarding the vaccine doses, a total of 9,595 patients formed the study population of the present investigation. If a COVID-19 infection occurred after the initial two vaccine doses and at least one booster dose (herein termed full vaccination), it was considered a BTI. Data were analysed using multivariable regression models.

Results Among SLE patients, 867/1,218 (71.2%) were fully vaccinated. BTI frequencies in fully vaccinated SLE patients were comparable to those of other AIRDs (OR: 1.0; 95% CI: 0.8–1.3; p=0.447) and nrAIDS (OR: 0.9; 95% CI: 0.6–1.3; p=0.856) but higher compared with HCs (OR:1.2; 95% CI: 1.0–1.6; p=0.022). Compared with HCs (OR: 10.6; 95% CI: 1.2–93.0; p=0.032) and other AIRDs (OR: 3.5; 95% CI: 1.08–11.5; p=0.036), SLE patients showed higher frequencies of hospitalisation.

Conclusions COVID-19 BTIs occurred in nearly 1 every 6th fully vaccinated patient with SLE. Moreover, BTIs in SLE patients were more severe compared with BTIs in HCs or patients with AIRDs other than SLE, resulting in a greater need for hospitalisation. These insights call for greater attention to vaccination in the vulnerable group of SLE patients, with appropriate risk stratification towards optimised vaccination strategies.

  • Systemic lupus erythematosus
  • Vaccination/Immunization

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.