Early vs Deferred Non–Messenger RNA COVID-19 Vaccination Among Chinese Patients With a History of Inactive Uveitis

Abstract

ImportanceImproper host response to COVID-19 vaccines could trigger immune-mediated adverse events. The question remains whether COVID-19 vaccination should be postponed until complete remission in patients with uveitis, a preexisting immune-related condition.ObjectiveTo compare recommendations for early and deferred COVID-19 vaccination with respect to uveitis outcomes.Design, Setting, and ParticipantsThis open-label, randomized clinical trial at a large, specialized teaching center for uveitis care in China enrolled unvaccinated patients with inactive uveitis between August 10, 2021, and February 22, 2022, with follow-up to June 6, 2022.InterventionsParticipants were randomly assigned to receive recommendation for early or deferred COVID-19 vaccination after complete remission of uveitis. Non–messenger RNA (non-mRNA) COVID-19 vaccines were available in China during the trial.Main Outcomes and MeasuresThe primary outcome was the time to symptomatic uveitis worsening during 3 months of follow-up. Secondary outcomes included uveitis activity and best-corrected visual acuity at 3 months.ResultsOf the 543 participants (304 women [56.0%]; median age, 35 [IQR, 26-49] years), 262 were recommended for early vaccination and 281 for deferred vaccination. By month 3, 109 patients (41.6%) in the early group had been vaccinated compared with 14 (5.0%) in the deferred recommendation group. In the intention-to-treat population, the time to symptomatic uveitis worsening was shorter in the early group than in the deferred group (hazard ratio, 1.68 [95% CI, 1.09-2.59]; P = .01 by log-rank test). Changes in anterior chamber cells, vitreous haze, and best-corrected visual acuity from baseline to month 3 appeared similar in the 2 groups in the evaluable population after the month 3 in-person visit.Conclusions and RelevanceIn this randomized clinical trial of patients with inactive uveitis, recommendation for early non-mRNA COVID-19 vaccination resulted in a higher incidence of self-reported symptomatic uveitis worsening with possible reporting bias compared with recommendation for deferred vaccination, but no adverse effects were observed in disease and visual prognosis at 3 months. These findings would be useful to guide the individual timing choices of non-mRNA COVID-19 vaccination in this clinically vulnerable population.Trial RegistrationChinese Clinical Trial Registry: ChiCTR2100049467

Reactivation of previously controlled Vogt–Koyanagi–Harada disease more than 46 years following COVID-19 vaccination: a case study

“…The authors found no evidence that uveitis activity or visual acuity at 3 months differed substantially based on the recommendation. 19 Because our patient received an mRNA COVID-19 vaccine, simple comparison is difficult; however, the results of this earlier study may be useful.…”

“…If she had received systemic glucocorticoids after vaccination, the VKH disease may not have recurred. Furthermore, Zhong et al 19 showed that compared with the recommendation for deferred vaccination, the recommendation for patients with inactive uveitis to receive early non-mRNA COVID-19 vaccination led to earlier self-reported worsening of symptomatic uveitis. The authors found no evidence that uveitis activity or visual acuity at 3 months differed substantially based on the recommendation.…”

Update on coronavirus disease 2019: Ophthalmic Manifestations and Adverse Reactions to Vaccination

“…The results showed a shorter time to symptomatic uveitis flare in the early vaccination group (HR = 1.68; P = 0.01), though there were no significant differences in objective uveitis activity or visual acuity between the groups at 3 months. It was, therefore, concluded that early non-mRNA COVID-19 vaccination was linked to a higher incidence of symptomatic uveitis worsening, possibly due to reporting bias, but did not affect disease or visual outcomes at 3 months 90 …”

“…It was, therefore, concluded that early non-mRNA COVID-19 vaccination was linked to a higher incidence of symptomatic uveitis worsening, possibly due to reporting bias, but did not affect disease or visual outcomes at 3 months. 90 In summary, although COVID-19 vaccination has been associated with a broad spectrum of ocular inflammation manifestations, the current evidence remains inconclusive regarding whether these vaccines are truly a cause of de novo disease. However, there appears to be an association with the reactivation of preexisting uveitis.…”