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Evaluating Safety and Healthcare Utilization

The following is a summary of “Safety and Health Care Use Following COVID-19 Vaccination Among Adults With Rheumatoid Arthritis: A Population-Based Self-Controlled Case Series Analysis,” published in the October 2023 issue of Rheumatology by Lee et al.

Researchers conducted a retrospective study investigating the association between COVID-19 vaccines and adverse events of special interest (AESIs) and healthcare utilization among adults with rheumatoid arthritis (RA).

They conducted a self-controlled case series (SCCS) analysis among adults with RA who had received at least 1 COVID-19 vaccine. The analysis assessed relative incidence (RI) rates of AESIs (Bell palsy, idiopathic thrombocytopenia, acute disseminated encephalomyelitis, pericarditis/myocarditis, Guillain-Barré syndrome, transverse myelitis, myocardial infarction, anaphylaxis, stroke, deep vein thrombosis, pulmonary embolism, narcolepsy, appendicitis, and disseminated intravascular coagulation) within any 21-day post-vaccination period compared to control periods. Secondary outcomes included ED visits, hospitalizations, and rheumatology visits. Created a matched non-RA comparator group and conducted a separate SCCS analysis, utilizing relative incidence ratios (RIRs) to compare RA and non-RA groups.

The results showed 123,466 RA patients and 493,864 comparators. In comparison to control periods, AESIs did not increase for RA patients. ED visits rose after dose 2 (RI 1.06, 95% CI 1.03-1.10) and decreased after dose 3 (RI 0.93, 95% CI 0.89-0.96). Hospitalizations decreased after the first (RI 0.83, 95% CI 0.78-0.88), second (RI 0.86, 95% CI 0.81-0.92), and third (RI 0.89, 95% CI 0.83-0.95) doses. Rheumatology visits increased after dose 1 (RI 1.08, 95% CI 1.07-1.10) and decreased after doses 2 and 3. Compared to comparators, RA patients had a higher AESI risk after dose 3 (RIR 1.28, 95% CI 1.05-1.56). RA patients had fewer ED visits (RIR 0.73, 95% CI 0.58-0.90) and hospitalizations (RIR 0.52, 95% CI 0.36-0.75) after dose 4.

They concluded that COVID-19 vaccination did not significantly increase the risk of adverse events or healthcare utilization in patients with RA.

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