COVID-19 vaccines immunogenic in people with rheumatic diseases
medwireNews: Messenger (m)RNA vaccines against SARS-CoV-2 elicit an appropriate immune response without triggering flares in people with chronic inflammatory diseases (CIDs) receiving immunosuppressive therapy, researchers report.
“Thus, we strongly recommend continued vaccination of immunosuppressed patients,” say Bimba Hoyer (University Medical Center Schleswig-Holstein Campus Kiel, Germany) and co-authors.
The study included 26 patients with CIDs – including rheumatoid arthritis, psoriatic arthritis, spondyloarthropathies, and psoriasis – and 42 healthy controls who had received both doses of the Pfizer–BioNTech (BNT162b2) or Moderna (mRNA-1273) vaccine. The majority of participants in both groups were healthcare workers, and none had been diagnosed with COVID-19 prior to vaccination.
As reported in the Annals of the Rheumatic Diseases, average levels of immunoglobulin G antibodies against the SARS-CoV-2 spike protein were significantly lower in the CID than the control group 1 week after the second vaccination, at 2053 versus 2685 binding antibody units/mL. However, all patients had titers above the cutoff for the enzyme-linked immunosorbent assay used.
The researchers also stress that all CID patients had “considerable levels” of neutralizing antibodies at the same timepoint, albeit significantly lower in the CID than the control group, with mean inhibitory activity levels of 87.42% versus 96.04%.
When comparing the most commonly used treatments in the CID cohort – tumor necrosis factor inhibitors, conventional DMARDs, and interleukin-17 inhibitors – there were no significant between-group differences in antibody levels. However, Hoyer and team caution that “treatment groups were small,” and “generalising from these data might be inappropriate.”
The researchers report that, in general, the adverse event (AE) profile was comparable among people with and without CIDs, but rates of mild systemic AEs such as fatigue (53.8 vs 43.2%) and myalgia (42.3 vs 31.6%) were higher in the CID group.
Disease activity in people with CIDs was measured before and 1 week after each vaccination, and no flares were reported. There were also no adjustments to DMARD or glucocorticoid therapy during the study period.
“Our data demonstrate for the first time that patients with a selection of immunosuppressive therapies for CID are able to mount an effective immune response after SARS-CoV-2 mRNA vaccination without significant side effects or flares,” write the investigators.
They caution, however, that their study cohort had a limited duration of follow-up, and “currently we cannot be certain of antibody titre persistence” in immunosuppressed individuals.
Furthermore, Hoyer et al say that further research is needed to investigate whether the between-group differences in antibody titers impact long-term immunity following COVID-19 vaccination.
“The possibility remains that immunosuppressed patients will need a booster (comparable with hepatitis B vaccination) if their antibody titres diminish more rapidly than [those in] healthy individuals,” they conclude.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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