Booster COVID-19 Vaccines for Immune-Mediated Inflammatory Disease Patients: A Systematic Review and Meta-Analysis of Efficacy and Safety

Abstract

Background: Seroconversion and longevity of vaccine-induced immune response is blunted in immune-mediated inflammatory disease (IMID) patients owing to immunosuppressive regimens. COVID-19 booster vaccines after a primary series have been proposed with inconclusive evidence on efficacy to date. Methods: This PROSPERO-registered systematic review (CRD42022302534) was conducted according to PRISMA guidelines. PubMed, EMBASE, CENTRAL, Web of Science, CORD-19, WHO ICTRP, and medRxiv were searched up to 28 February 2022 for eligible studies. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Results: From 6647 records, 17 prospective studies were included for systematic review and 12 in meta-analysis of primary series non-responders. The risk of bias was low. Pooling 340 non-responders, a booster dose proved effective with 0.47 seroconverting (95% CI: 0.32–0.63, I2 = 82%). Rituximab therapy was associated with significant impairment, with risks of 0.25 (95% CI: 0.17–0.36, I2 = 50.7%) versus 0.81 (95% CI: 0.72–0.87, I2 = 0.0%) for those without rituximab therapy. A systematic review of antibody levels against COVID-19 showed several-fold increases across studies. Incidence of local and systemic adverse events, including disease flares, were either comparable or slightly increased after the booster dose compared to primary series. No major events such as myocarditis or death were reported. Conclusion: Our results show that booster doses are effective in eliciting seroconversion in non-responders, bolstering immunity to COVID-19. It has also not been associated with major adverse events.

Booster doses of COVID-19 vaccines for patients with haematological and solid cancer: a systematic review and individual patient data meta-analysis

“…General considerations for timing the vaccination chiefly revolve around the return to activities of daily life and restoration of normal blood counts [57]. Overall, similar to other immunocompromised groups receiving immunosuppressive therapy, such as patients with immune-mediated inflammatory diseases and solid organ transplant recipients, booster doses are crucial to afford protection against COVID-19 [58,59].…”

Seroconversion among rituximab-treated patients following SARS-CoV-2 vaccine supplemental dose

“…A recent meta-analysis showed that patients on anti-CD20 + therapy had a much lower rate of seroconversion following the booster dose compared to patients receiving non-anti-CD20 + therapy (25% vs 81%). [ 10 ] In our study, approximately one third of the patients who did not initially mount an antibody response to COVID-19 vaccination, were positive after the supplemental dose. This again supports an increase in seroconversion with additional doses, albeit lower than in patients not on RTX.…”

Adult-Onset Still’s Disease-like Syndrome following COVID-19 Vaccination: A Case Report and Review of the Literature

“…Another report found that the incidence of adverse events was similar between patients with rheumatic diseases and healthy controls, with a low incidence of flare (<5%) among the former [ 45 ]. A recent meta-analysis on the effect of COVID-19 vaccine booster doses in patients with pre-existing immune-mediated rheumatic diseases found that the incidence of local and systemic adverse events, including disease flares, was either comparable or slightly increased when compared with the primary series of vaccinations [ 46 ]. This information suggests a very low risk of vaccines that might trigger a flare.…”