Objectives/Goals: Little is known about how long COVID-19 vaccines protect patients with autoimmune diseases or about breakthrough infection risk factors in this population. We aimed to evaluate vaccine protection durability and identify predictors of breakthrough infection among vaccinated autoimmune patients in Qatar. Methods/Study Population: In a retrospective cohort study in Qatar, we included patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or Hashimoto’s thyroiditis who received at least one COVID-19 vaccine dose. Follow-up started 14 days post-first dose and continued until breakthrough infection or April 30, 2023. Data on demographics, comorbidities, vaccination history, and prior infections were collected. Cox proportional hazards models with time since last dose as a time-varying exposure were used to estimate adjusted hazard ratios (aHRs) for breakthrough infection, adjusting for age, sex, autoimmune condition, and prior infection. Results/Anticipated Results: Among 6,039 vaccinated autoimmune patients, 1,350 had a breakthrough infection during follow-up. Breakthrough risk did not increase significantly within the first 6 months (aHR ~1.17 at 91–180 days vs 0–90 days), but was about twofold higher by 6–12 months (aHR 2.03) and remained elevated beyond one year (aHR 1.78). Male sex was protective, associated with ~30% lower risk than female sex (aHR 0.70), with an even larger advantage at >360 days (interaction p<0.05). Rheumatoid arthritis was associated with lower breakthrough risk than Hashimoto’s (aHR 0.69), and systemic lupus erythematosus had slightly lower risk (aHR 0.86). Prior SARS-CoV-2 infection also conferred additional protection (aHR 0.68). Discussion/Significance of Impact: COVID-19 vaccine protection in autoimmune patients wanes by six months. Male sex and prior infection conferred protection against breakthrough infection. RA and SLE did not show a higher risk than Hashimoto’s. These findings support booster doses around six months and highlight the need for tailored preventive strategies.
Al‐Khinji et al. (Wed,) studied this question.