COVID vaccine linked to far fewer hospital stays in rheumatic disease

Clinical takeaway: Encourage updated COVID immunization in patients with autoimmune rheumatic conditions. Staying current was associated with substantially lower chances of poor outcomes, even for those who completed an initial series. Expect most of these patients not to be current on these vaccinations. 

Patients with autoimmune rheumatic conditions sit near the top of the risk pyramid for severe COVID-19, threatened both by their underlying disease and by the immunosuppressive therapies that control it. Yet COVID vaccination has slipped down the priority list in many exam rooms. Uptake of the newest formulations has thinned even among the patients with the most to lose. 

Immunocompromised patients mount weaker responses to immunization. Most prior work in rheumatic disease stopped at the primary series and the early boosters. Whether the newest formulations carry their protective association into patients taking rituximab, glucocorticoids, or other immunosuppressants had not been tested at scale. A large retrospective analysis of US adults with autoimmune rheumatic conditions, running through mid-2024, now supplies that data. Its findings give the vaccine conversation firmer footing than it has had since the updated formulas first arrived. 

Hospitalization risk ran 18.3% among patients with no vaccination or the initial series alone, against 8.2% among those who had received a booster or updated dose. Overall, 18 patients holding only the initial series would need one additional dose, whether an earlier booster or the updated formula, to prevent one COVID-related hospitalization. 

Updated vaccination, defined as any dose received on or after the 2023–2024 formula's September 2023 rollout regardless of prior history, was associated with 69% lower adjusted odds of COVID-related hospitalization compared with no vaccination. Booster vaccination, an initial series plus at least one additional dose before the updated formula arrived, carried 71% lower odds; the initial series alone, 41%. Yet just 6,336 of the 60,980 patients analyzed, about 10%, had received an updated dose. 

The associations extended to the outcomes that put rheumatic patients in intensive care. Updated vaccination was tied to 76% lower adjusted odds of mechanical ventilation or ECMO and 97% lower adjusted odds of COVID-related death versus no vaccination, both statistically significant. Booster vaccination showed similar patterns. The findings held across age, sex, type of rheumatic condition, immunosuppressive medication exposure, and social vulnerability. 

The analysis drew on National Clinical Cohort Collaborative EHR records from 86 US sites, covering adults with autoimmune rheumatic conditions and incident COVID-19 between December 2020 and August 2024. Mixed-effects logistic regression treated vaccination as a time-varying exposure and adjusted for demographics, rheumatic condition, medication use, comorbidities, and social vulnerability. 

The authors point toward improving and creating targeted efforts to keep rheumatic patients current as COVID vaccine recommendations continue to evolve. They also position the results to inform policy decisions on whether updated vaccination stays on the schedule for immunocompromised groups. The bottleneck is not hesitancy alone, but also the drift of COVID vaccination down the clinical priority list. Reversing it falls largely to the clinicians these patients see most. 

"Our findings provide important real-world evidence that updated vaccines continue to offer substantial protection in this medically vulnerable population," said Maria I. Danila, MD, MSc, MSPH, of the University of Alabama at Birmingham. 

Source: Jackson LE, et al. (2026 Sep 9) Arthritis Rheumatol. Updated COVID-19 Vaccines and Health Outcomes in Patients With Autoimmune Rheumatic Conditions