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Everyone has been impacted by the coronavirus pandemic over the past couple of years. The pandemic has weighed heavily on the minds of patients with chronic inflammatory diseases (CID) given their immunosuppressed status either from their inherent disease or the necessary immunomodulatory treatments.

In Yang and colleagues present a study of 441 patients, 322 with CID and 119 controls, in which mRNA SARS-CoV-2 vaccines side effects were correlated with antibody titer. It is worth noting that this a substudy of a larger longitudinal, prospective, observational study at two large academic medical centers in the United States.

In the present study, patients with CID experienced significantly more adverse effects compared to controls, typically following the first dose of vaccine. In turn, this did correlate with higher spike protein antibodies. The novelty of this study lies in the fact that it is the first to examine this connection in CID patients.

There are limitations in the sample size, with only several hundred patients included, although, outcomes from the larger longitudinal, prospective study will further expand our understanding of the correlation between reactogenicity and immunogenicity. The heterogeneous study population is another concern. Does a patient with rheumatoid arthritis correlate to a patient with inflammatory bowel disease or another with vasculitis? How do we compare patients with an antibody-driven autoimmune disease to those with diseases driven by other mechanisms? Chronic inflammatory diseases employ a wide range of immunosuppressive treatments, and no two patients are the same. What role do these medications play in reactogenicity and immunogenicity?

The take away for us as rheumatologists is that we now have more data (and more questions) that we can share with our patients in terms of expectations related to mRNA SARS-CoV-2 vaccines, adverse reactions after vaccine, and preliminary steps regarding connections to immunogenicity.

Emily L. Gilbert, MD, PhD, is a rheumatologist in Jacksonville, Florida.

Read the study here and a Q&A with the first study author here.