Abstract
Purpose :
To date, many case reports have detailed the onset of non-infectious uveitis (NIU) following COVID-19 vaccination, contributing to vaccine hesitancy; however, no large-scale analytical studies have examined this association in the United States. In this study, two population-based comparative methodologies were implemented to assess risk of NIU following COVID-19 vaccination in patients with and without prior history of the disease in the United States.
Methods :
This study used de-identified healthcare claims data from OptumLabs® Data Warehouse. To investigate incident NIU risk after vaccination in patients without prior NIU, a matched cohort analysis was conducted comparing a COVID-19 vaccinated cohort to an unvaccinated historical cohort. Cox proportional hazards regression models were applied to estimate hazard ratios. Additionally, a self-controlled case series (SCCS) design was used to compare the incidence of NIU in exposed post-vaccine risk periods and unexposed control periods, remote from vaccination, within the same individual. Conditional Poisson regression was used to estimate incidence rate ratios. To investigate recurrent NIU risk in patients with prior history of the disease, the SCCS model was used and additionally accounted for time since last flare.
Results :
In evaluating incident NIU risk, 4,611,378 patients were included in the matched cohort analysis (mean age [SD] = 43.5 [17.7] years, 50.8% female). The adjusted hazard ratio comparing NIU incidence in the cohorts was 0.91 (95% CI: 0.75-1.10, p = 0.33). In the SCCS analysis, 686 patients were included (52.9 [15.0] years, 56.7% female). The incidence rate ratio (IRR) comparing post-vaccine NIU risk to risk during the control intervals was 1.05 (95% CI: 0.89-1.23, p = 0.57). In evaluating recurrent risk, 412 patients with prior NIU were included in the SCCS analysis (51.5 [15.1] years, 60.7% female). The IRR comparing post-vaccine risk to risk in the control intervals was 1.29 (95% CI: 1.02-1.62, p = 0.03).
Conclusions :
This study’s matched cohort and SCCS analyses did not detect an increased risk of NIU following COVID-19 vaccination in individuals without prior NIU, providing reassurance about the vaccine's safety. There was an increased risk of NIU post-vaccination in patients with prior NIU, which may be due to immune activation from vaccination. This finding merits further study and may have clinical implications for this population.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.