Clinical efficacy of the fourth dose of the BNT162b2 vaccine in maintenance dialysis patients

Cohen-Hagai, Keren; Hornik-Lurie, Tzipi; Benchetrit, Sydney; Nacasch, Naomi; Grupper, Ayelet; Einbinder, Yael; Wand, Ori; Shashar, Moshe

doi:10.1007/s40620-023-01667-z

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…However, there is currently insufficient evidence to validate the need for a fourth or fifth booster dose. Emerging evidence shows that a fourth booster vaccine increases antibody response and reduces mortality in HD patients, but only few studies consider differences in vaccine response between COVID-19-infected and naïve dialysis patients as well as the dynamics of antibody response throughout the vaccination course [23][24][25]. Therefore, we examined the effect of a fourth SARS-CoV-2 vaccine for boosting antibody response in HD patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Humoral Response between Third and Fourth Doses of COVID-19 Vaccine in Hemodialysis Patients

Joo,

Kim,

Jeon

et al. 2023

Vaccines

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Dialysis patients are more likely to die or become hospitalized from coronavirus disease 2019 (COVID-19). Currently, only a few studies have evaluated the efficacy of a fourth booster vaccination in hemodialysis (HD) patients and there is not enough evidence to recommend for or against a fourth booster vaccination. This study compared the humoral response and disease severity of patients on HD who received either three or four doses of COVID-19 vaccine. A total of 88 patients were enrolled. Humoral response to vaccination was measured by quantifying immunoglobulin G levels against the receptor binding domain of SARS-CoV-2 (anti-RBD IgG) at five different times and plaque reduction neutralization tests (PRNT) at two different times after vaccination over a period of 18 months. Antibody levels were measured at approximately two-month intervals after the first and second dose, then four months after the third dose, and then one to six months after the fourth dose of vaccine. PRNT was performed two months after the second and four months after the third dose of vaccine. We classified patients into four groups according to the number of vaccine doses and presence of COVID-19 infection. Severe infection was defined as hospital admission for greater than or equal to two weeks or death. There was no difference in antibody levels between naïve and infected patients except after a fourth vaccination, which was effective for increasing antibodies in infection-naïve patients. Age, sex, body mass index (BMI), dialysis vintage, and presence of diabetes mellitus (DM) did not show a significant correlation with antibody levels. Four patients who experienced severe COVID-19 disease tended to have lower antibody levels prior to infection. A fourth dose of SARS-CoV-2 vaccine significantly elevated antibodies in infection-naïve HD patients and may be beneficial for HD patients who have not been previously infected with SARS-CoV-2 for protection against severe infection.

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Section: Introductionmentioning

confidence: 99%

Comparison of Humoral Response between Third and Fourth Doses of COVID-19 Vaccine in Hemodialysis Patients

Joo,

Kim,

Jeon

et al. 2023

Vaccines

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“…Despite the hesitancy or reluctance of some CDR to receive booster doses, the present study indicates a positive association between receiving increased doses of COVID-19 vaccine and lower risks of COVID-19-related hospitalization and death. To date, only one study conducted by Cohen-Hagai et al,28 based on the data from 1030 patients compared the clinical efficacy of receiving a fourth dose of vaccine versus three doses in dialysis patients, with a corresponding 44% lower risk of COVID-19-related mortality. In our study, receiving a fourth dose versus three doses was associated with a 12% lower risk of all-cause mortality, and a 24% lower risk of COVID-19-related hospitalization.…”

mentioning

confidence: 99%

Evolving impact of the COVID-19 pandemic in chronic dialysis recipients over the course of pandemic waves and COVID-19 vaccination rollout: a French national study

Leye,

El Karoui,

Delory

et al. 2024

Preprint

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Summary Background: This observational study aims to assess the impact of the pandemic on the evolving of kidney transplantations, survival, and vaccination in chronic dialysis recipients (CDR) over the COVID-19 pandemic subperiods. Methods Using the French national health claims database, incident persons with end stage kidney disease in years 2015 to 2021 treated with dialysis were followed-up until December 31, 2022. Kidney transplantion and survival over pandemic subperiods versus the prepandemic period were investigated using longitudinal models with time-dependent covariates. Moreover, the impact of cumulative doses of COVID-19 vaccine on hospitalization and survival were compared between CDR and matched-control individuals. Findings Follow-up of the 71,583 CDR and 143,166 controls totalized 639,341 person-years (CDR: 184,909; controls: 454,432). The likelihood of receiving a kidney transplant decreased during all pandemic subperiods except one. Mortality in CDR increased during the 3 wave subperiods (hazard ratio (HR [95% confidence interval]): 1.19 [1.13-1.27], 1.19 [1.15-1.23], and 1.12 [1.07-1.17], respectively). While vaccine coverage declined with each booster dose, receiving such doses was associated with lower risks of COVID-19-related hospitalization (0.66 [0.56-0.77], 0.83 [0.72-0.94] for 1st booster versus 2nd dose and 2nd booster versus 1st booster, respectively) and death (corresponding HR: 0.55 [0.51-0.59], 0.88 [0.83-0.95]). Evolving patterns in mortality and vaccination outcomes were similar in CDR and controls. Interpretation The impact of the pandemic in CDR was not specific of the kidney disease per se. Study results also suggest future research aimed at increasing adherence to vaccine booster doses.

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SARS-CoV-2 spike protein antibody titers after the fourth dose of BNT162b2 vaccine among Japanese patients undergoing hemodialysis: a single-center study

Watanabe,

Sawano,

Saito

et al. 2024

Front. Immunol.

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Patients undergoing hemodialysis are particularly vulnerable to severe outcomes of SARS-CoV-2 infection, with mortality rates higher than that of the general population. Vaccination reduces the risk of adverse outcomes, with booster doses being particularly beneficial. However, limited data are available on the effectiveness of subsequent vaccinations or their effect on increasing antibody levels. This single-center study aimed to investigate changes in SARS-CoV-2 IgG antibody titers following the fourth vaccination among 28 patients undergoing hemodialysis. Blood tests were conducted at various intervals post-vaccination, with a focus on identifying factors associated with antibody levels. The IgG antibody levels rapidly increased by Day 7 post-vaccination, with a median time to peak of 11 days. Antibody titers tended to be higher in male patients than in female patients. This study sheds light on the immune response to the fourth vaccination in patients undergoing hemodialysis. As this study included a small sample size, with a short observation period, further research is warranted to comprehensively understand the effectiveness of vaccination and the benefits of additional doses of vaccine.

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Clinical efficacy of the fourth dose of the BNT162b2 vaccine in maintenance dialysis patients

Cited by 3 publications

References 24 publications

Comparison of Humoral Response between Third and Fourth Doses of COVID-19 Vaccine in Hemodialysis Patients

Comparison of Humoral Response between Third and Fourth Doses of COVID-19 Vaccine in Hemodialysis Patients

Evolving impact of the COVID-19 pandemic in chronic dialysis recipients over the course of pandemic waves and COVID-19 vaccination rollout: a French national study

SARS-CoV-2 spike protein antibody titers after the fourth dose of BNT162b2 vaccine among Japanese patients undergoing hemodialysis: a single-center study

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