Abstract: medRxiv preprint doi: https://doi.org/10.1101/2022.07.13.22277606; this version posted July 15, 2022. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Breakthrough infections in rheumatic disease patients Running Head: Breakthrough infections in rheumatic disease patients Title: Factors Associated with COVID-19 Breakthrough Infection in the Pre-Omicron Era Among Vaccinated Patients with Rheumatic Diseases: A Cohort Study Authors: Naomi J. Patel, MD1,4; Xiaosong Wang, MS2, Xiaoqing Fu, MS1; Yumeko Kawano, MD2,4; Claire Cook, MPH1,3; Kathleen M.M. Vanni, BA2; Grace Qian, BA&Sc2; Emily Banasiak, BA2; Emily Kowalski, BS2; Yuqing Zhang, ScD1,3,4; Jeffrey A. Sparks, MD, MMSc2,4*; Zachary S. Wallace, MD, MSc1,3,4* *These authors contributed equally to this work (co-last authors). Affiliations: 1 Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114) 2 Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115) 3 Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA (The Mongan Institute, 100 Cambridge Street, Suite 1600, Boston, MA, 02114) 4 Harvard Medical School, Boston, MA. Financial Support 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2022.07.13.22277606; this version posted July 15, 2022. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Breakthrough infections in rheumatic disease patients NJP is supported by the Rheumatology Research Foundation. JAS is funded by NIH/NIAMS (grant numbers, R01 AR077607, P30 AR070253, and P30 AR072577), the R. Bruce and Joan M. Mickey Research Scholar Fund, and the Llura Gund Award for Rheumatoid Arthritis Research and Care. ZSW is funded by NIH/NIAMS [K23AR073334 and R03AR078938]. Declaration of interests NJP reports consulting fees from FVC Health unrelated to the current work. JAS reports research support from Bristol Myers Squibb and consultancy fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer. ZSW reports research support from Bristol-Myers Squibb and Principia/Sanofi and consulting fees from Zenas Biopharma, Horizon, Sanofi, Shionogi, Viela Bio, and MedPace. All other authors report no competing interests. Corresponding authors: Zachary S. Wallace, MD, MSc Clinical Epidemiology Program Division of Rheumatology, Allergy, and Immunology Massachusetts General Hospital 100 Cambridge Street, 16th Floor Boston, MA 02114 617-724-2507 zswallace@mgh.harvard.edu @zach_wallace_md 2 medRxiv preprint doi: https://doi.org/10.1101/2022.07.13.22277606; this version posted July 15, 2022. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It..