Abstract: Journal Pre-proof Factors Associated with COVID-19 Breakthrough Infection Among Vaccinated Patients with Rheumatic Diseases: A Cohort Study Naomi J. Patel , Xiaosong Wang , Xiaoqing Fu , Yumeko Kawano , Claire Cook , Kathleen M.M. Vanni , Grace Qian , Emily Banasiak , Emily Kowalski , Yuqing Zhang , Jeffrey A. Sparks , Zachary S. Wallace PII: DOI: Reference: S0049-0172(22)00159-7 https://doi.org/10.1016/j.semarthrit.2022.152108 YSARH 152108 To appear in: Seminars in Arthritis & Rheumatism Please cite this article as: Naomi J. Patel , Xiaosong Wang , Xiaoqing Fu , Yumeko Kawano , Claire Cook , Kathleen M.M. Vanni , Grace Qian , Emily Banasiak , Emily Kowalski , Yuqing Zhang , Jeffrey A. Sparks , Zachary S. Wallace , Factors Associated with COVID-19 Breakthrough Infection Among Vaccinated Patients with Rheumatic Diseases: A Cohort Study, Seminars in Arthritis & Rheumatism (2022), doi: https://doi.org/10.1016/j.semarthrit.2022.152108 This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2022 Elsevier Inc. All rights reserved. Factors Associated with COVID-19 Breakthrough Infection Among Vaccinated Patients with Rheumatic Diseases: A Cohort Study Naomi J. Patel1,4; Xiaosong Wang2, Xiaoqing Fu1; Yumeko Kawano2,4; Claire Cook1,3; Kathleen M.M. Vanni2; Grace Qian2; Emily Banasiak2; Emily Kowalski2; Yuqing Zhang1,3,4; Jeffrey A. Sparks2,4*; Zachary S. Wallace1,3,4,*,# zswallace@mgh.harvard.edu 1 Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA 2 Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA, 02115, USA 3 Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, The Mongan Institute, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA 4 Harvard Medical School, Boston, MA * Corresponding author: Zachary S. Wallace, Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114 * These authors contributed equally to this work (co-last authors). Abstract Objective: Rheumatic disease patients on certain immunomodulators are at increased risk of impaired humoral response to SARS-CoV-2 vaccines. We aimed to identify factors associated with breakthrough infection among patients with rheumatic diseases. Methods: We identified patients with rheumatic diseases being treated with immunomodulators in a large healthcare system who received at least two doses of either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) vaccines or one dose of the Johnson & JohnsonJanssen (J&J) vaccine. We followed patients until SARS-CoV-2 infection, death, or December 15, 2021, when the Omicron variant became dominant in our region. We estimated the association of baseline characteristics with the risk of breakthrough..