CD20 inhibitors and glucocorticoid monotherapy were associated with an increased risk of COVID-19 breakthrough infection among patients with rheumatoid arthritis (RA), Abigail Schiff, MD, said during her presentation at the ACR Convergence on November 13.

Dr Schiff is a resident in internal medicine at Brigham and Women's Hospital in Boston, Massachusetts.

The findings highlight the excess risk associated with glucocorticoid monotherapy or CD20 inhibitor use for RA treatment. “By identifying important subgroups for counseling and placing into action additional risk mitigation strategies, we can solve for this problem proactively,” Dr Schiff said.

For the retrospective cohort study, Dr Schiff and colleagues identified 5781 patients with RA using a combination of disease-modifying antirheumatic drugs and glucocorticoids who contracted SARS-CoV-2 infection. Covariates included demographics, lifestyle, comorbidities, and prior COVID-19.

Users of CD20i were more likely than tumor necrosis factor inhibitor users to have COVID-19 after the index date (adjusted HR 1.74, 95%CI 1.30-2.33), as were users of steroid monotherapy (adjusted HR 1.47, 95%CI 1.09-1.98)

The explanation is simple, Dr Schiff explained. “Some immunomodulator medications, particularly CD20 inhibitors, may impact vaccine immunogenicity and waning.” Studying the impact of additional vaccine doses, the timing and frequency, and other protective measures may help support the findings.

Reference:
Schiff A. 1272-Immunomodulators and risk for breakthrough COVID-19 after a third SARS-CoV-2 mRNA vaccine among patients with rheumatoid arthritis: A cohort study. Presented at: American College of Rheumatology Convergence. November 13, 2023. San Diego.