- In a population-level study of 1,105 adults with stable glomerular disease (a type of autoimmune kidney disease), a first dose of a COVID-19 vaccine was not associated with risk of relapse ; however, receiving a subsequent vaccine dose was associated with a twofold higher relative risk of relapse.
- Importantly, the increase in absolute risk associated with vaccination was small (1-5% depending on the type of glomerular disease) and most disease outbreaks associated with the vaccine were mild.
Washington, DC (November 3, 2022) — Several reports have described relapse of certain autoimmune kidney diseases in patients after receiving COVID-19 vaccines, but whether this association is real or coincidental is unclear. In a recent population-level study published in JASNinvestigators found that a second or third dose of COVID-19 vaccine was associated with a higher relative risk but a small increased absolute risk of disease relapse.
People with glomerular diseases – a group of autoimmune kidney diseases that often require long-term treatment with drugs that suppress the immune system – are at high risk of developing serious infections and are more likely to suffer from complications. infections such as COVID-19. As vaccination programs were rolled out, individual case reports began to emerge describing flare-ups of glomerular disease that occurred days to weeks after COVID-19 vaccines, suggesting that the vaccine itself even might have induced a flare-up of autoimmune kidney disease. These reports were very limited and, in the absence of a control population, were unable to provide accurate estimates of the actual risk of disease flare that may be associated with COVID-19 vaccines.
For clarity, a team led by Sean Barbour, MD, MSc (University of British Columbia) and Mark Canney, MD, PhD (University of Ottawa) studied information on all patients in British Columbia, in Canada, who suffered from the following glomerular diseases: changes disease, focal segmental glomerulosclerosis, membranous nephropathy, IgA nephropathy, lupus nephritis, glomerulonephritis related to cytoplasmic anti-neutrophil antibodies and C3 glomerulonephritis. By capturing all patients with biopsy-confirmed glomerular disease in a centralized provincial database with a link to both laboratory data and vaccination status over time, researchers quantified the absolute and relative risk of relapse of glomerular disease after vaccination against COVID-19.
The analysis identified 1,105 adults with glomerular disease that was stable when COVID-19 vaccines first became available. During the 281 days of follow-up, 134 patients (12.1%) experienced a relapse. Although a first dose of vaccine was not associated with risk of relapse, exposure to a second or third dose was associated with relative risk of relapse; However, the absolute the increased risk of disease flare after these doses was still small, ranging from 1 to 5% depending on the type of glomerular disease. Most vaccine-associated disease flares were mild, with around 1 in 5 people needing a change in treatment.
“These results indicate that although COVID-19 vaccines may be associated with a small increased risk of causing a flare-up of glomerular disease, this risk is very small, and the well-established benefits of vaccination further outweigh these risks. “, said Dr. Barbour. “This should encourage people with glomerular disease to continue getting regular COVID-19 vaccinations. Our results also suggest that people with glomerular disease should be carefully monitored after COVID-19 vaccinations to detect any early flare of their disease.
Dr Barbour added that the study demonstrates how individual reports of vaccine side effects can lead to unnecessary angst and worry in people deciding whether or not to receive COVID-19 vaccines. Instead, proper studies should be conducted to provide estimates of the actual risk, so people can be properly informed. “In this study, we have confirmed initial reports of a potential complication from COVID-19 vaccines, but we also demonstrate that this risk is very low and the severity of the complication was quite mild,” said Dr. Barbour.
An accompanying editorial notes that the results provide important information when discussing the advantages and the inconvenients of COVID-19 vaccination in patients with glomerular disease.
Additional co-authors include Mohammad Atiquzzaman, PhD, Amanda M. Cunningham, MD, Yuyan Zheng, MSc, Lee Er, MSc, Steven Hawken, PhD, and Yinshan Zhao, PhD.
Disclosures: The authors reported no financial disclosures.
The article, titled “A population-based analysis of the risk of relapse of glomerular disease after vaccination against COVID-19” will be published online at http://jasn.asnjournals.org/ on November 3, 2022; doi: 10.1681/ASN.2022030258.
The editorial, entitled “COVID-19 mRNA vaccines and their risk of inducing relapse of glomerular diseases” will appear online at http://jasn.asnjournals.org/ on November 3, 2022; doi: 10.1681/ASN/2022091078.
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