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  • COVID-19 vaccine can be given to patients whose uveitis is not in remission

    Uveitis

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    Review of: Early vs deferred non–messenger RNA COVID-19 vaccination among Chinese patients with a history of inactive uveitis: A randomized clinical trial

    Zhong Z, Wu Q, Lai Y, et al. JAMA Network Open, February 2023

    An increased incidence of new-onset uveitis or uveitis relapse following COVID-19 vaccination has been noted in the literature. Therefore, in order to minimize the risk of uveitis flares and worsening disease, proper timing of COVID-19 vaccine administration for patients with uveitis is key.

    Study design

    A randomized, open-label clinical trial that was conducted at a teaching hospital in Chongqing, China, randomly assigned 543 patients aged ≥12 years with a history of uveitis to receive early or deferred non–messenger RNA COVID-19 vaccination. Uveitis was inactive for <3 months, but not in remission. “Deferred” vaccination was defined as deferred until after the uveitis was in remission. The primary outcome was time to symptomatic uveitis worsening during the 3 months of follow-up. Important secondary outcomes were uveitis activity and best-corrected visual acuity at 3 months.

    Outcomes

    Over the study period, symptomatic uveitis worsening was seen in 19.5% of patients in the early vaccination group and 12.1% of patients in the deferred vaccination group. Patients who received early COVID-19 vaccination had a shorter time to uveitis worsening than the patients who received deferred vaccination. No differences in visual acuity and intraocular inflammation were seen between the 2 groups at the 3-month follow-up exam, but more patients in the early vaccination group reported new-onset floaters.

    Limitations

    Because the study was not able to meet enrollment criteria, this limits the conclusions that can be made. There were a number of patients in both groups who did not receive the vaccine in both groups and did not participate in the in-person examination (approximately 45%). Patients were not masked to receiving or not receiving the vaccine, which may have contributed to the increased reporting of symptoms in the early vaccination group (performance bias).

    Clinical significance

    While conclusions are limited for this study, in general they support the use of COVID-19 vaccination in patients with uveitis who are not in complete remission. While symptoms were noted in the early vaccination group, uveitis activity and vision were similar between the early and deferred vaccination groups.

    Financial Disclosures: Dr. Jessica Shantha discloses no financial relationships.