May 10, 2021

Study assesses immune responses to vaccination against SARS-CoV-2 in patients with immune-mediated inflammatory diseases

Immune responses to vaccination against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were delayed and reduced in patients with immune-mediated inflammatory disease (IMID), according to a study published in Annals of the Rheumatic Diseases.

“The study shows that 1 out of 10 patients with an IMID fails to develop neutralising antibodies after SARS-CoV-2 vaccination, while it is only 1 out of 100 in healthy controls,” reported David Simon, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany, and colleagues. “Decreased immune response to SARS-CoV-2 vaccination is immanent to the presence of an IMID but not related to the individual immune-modulatory treatments.”

In the study, researchers analysed vaccination responses of 84 patients with IMID (mean age 53.1 years; 65.5% females) and 182 healthy controls (mean age, 40.8; 57.1% females) who had received at least one dose of the BNT162b2 vaccine (Pfizer-BioNTech) more than 10 days before serum collection. The vast majority (96%) of the cohort had received two doses of the vaccine. All of these individuals did not have a history of SARS-CoV-2 infection and were antibody negative before the vaccination. 

Most patients with IMID had spondyloarthritis (SpA/psoriatic arthritis; 32.1%), followed by rheumatoid arthritis (29.8%), inflammatory bowel disease (9.5%), psoriasis (9.5%) and systemic IMIDs (19.0%). About 42.9% of patients with IMID received biologic (b) or targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs), followed by conventional synthetic (cs) DMARDs (23.8%), while 24 (28.6%) patients received no treatment.

While all controls developed anti-SARS-CoV-2 immunoglobulin (Ig)G antibodies, the researchers found that 5 patients with IMID failed to develop a response (P = 0.003). On the other hand, an assessment of neutralisation activity of anti-SARS-CoV-2 antibodies showed that 99.5% of controls developed neutralising antibodies, while only 90.5% of patients with IMID developed neutralising activity (P = 0.0008).

Study data revealed that the overall mean (SD) optical density (OD) values were 6.47 (3.14) in patients with IMID compared with 9.36 (1.85) in controls (adjusted mean difference 1.58, 95% CI 0.98 to 2.19, P <0.001). Meanwhile, estimated marginal means adjusted for age, sex and time elapsed from first vaccination to sampling date were 8.48 (95% CI 8.12 to 8.85) for controls and 6.90 (95% CI 6.45 to 7.35) for patients with IMIDs. Further, linear regression model showed that vaccine responses were influenced by the presence of IMID, age, sex and time elapsed from vaccination. 

Among patients with IMID, overall mean ODs were similar across different IMID groups and lower than that of controls. When analysing different treatment regimen, the researchers found that patients with IMID treated with bDMARDs/tsDMARDs did not show a different response compared with patients receiving csDMARDs (mean OD [SD] 6.49 [2.91] vs 6.26 [3.00]; mean difference 0.23 [95% CI −0.83 to 1.30], P = 0.97) or to those without treatment (mean OD [SD] 6.49 [2.91] vs 6.64 [3.70]; mean difference −0.22 [95% CI −1.28 to 0.83], P = 0.97). 

“This study shows that SARS-CoV-2 vaccination essentially works in patients with IMID but responses are delayed and reduced. A minority of patients with IMID did not respond to the vaccine even after second immunisation, suggesting that in some cases the measurement of antibody levels after vaccination might be useful to ascertain development of immunity,” the authors concluded. 

SOURCE: Annals of the Rheumatic Diseases
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