Humoral and cellular immunogenicity of COVID-19 booster dose vaccination in inflammatory arthritis patients

Abstract

IntroductionPrevious studies have shown a reduction in the effectiveness of primary COVID-19 vaccination in patients with rheumatic diseases. However, limited data is available regarding the effectiveness of the COVID-19 vaccine booster dose, especially on cellular response. The study aimed to assess the humoral and cellular immunogenicity of a booster dose in patients with inflammatory arthritis (IA).Patients and methods49 IA and 47 age and sex-matched healthy controls (HC) were included in a prospective cohort study. Both groups completed primary COVID-19 vaccination and after more than 180 days received a BNT162b2 booster shot. Humoral responses (level of IgG antibodies) and cellular responses (IFN-γ production) were assessed before and after 4 weeks from the booster dose of the vaccine.ResultsAfter the booster dose, all participants showed an increased humoral response, although significantly reduced antibody levels were observed in IA patients compared to HC (p=0.004). The cellular response was significantly lower both before (p<0.001) and after (p<0.001) the booster dose in IA patients as compared to HC. Among the immunomodulatory drugs, only biological and targeted synthetic drugs lowered the humoral response after booster vaccination. However, the cellular response was decreased after all immunomodulatory drugs except IL-17 inhibitors and sulfasalazine.ConclusionOur data indicate that patients with rheumatic diseases present lower humoral and cellular responses after the COVID-19 booster vaccine in comparison to HC. This may translate into a recommendation for subsequent booster doses of the COVID-19 vaccine for rheumatic patients.

The Kinetics of Humoral and Cellular Responses after the Booster Dose of COVID-19 Vaccine in Inflammatory Arthritis Patients

“…The waning of humoral immunity after the COVID-19 booster seems to be slower than after the primary vaccination regimen—the levels of responses were higher at T2 than at T0 and none of the IA patients in our study lost the humoral response after more than 6 months from booster vaccination (compared to 20.4% of IA patients after more than 6 months from the primary schedule as reported in our previous study [ 36 ]). We also did not observe any difference in the level of humoral response 6 months after booster vaccination between patients who lost humoral immunity 6 months after primary vaccination and those who maintained it.…”

“…The abrogated immunological response to the primary vaccination schedule results in a faster decline of post-vaccination immunity in IA patients [ 5 , 7 , 16 , 18 , 25 , 26 ], making booster vaccinations among IA patients even more important than in HC. Current studies proved that, though COVID-19 booster vaccinations are effective in IA patients [ 27 , 28 , 29 ], also the immunogenicity of the booster dose is impaired in this group of patients [ 15 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. There are only single studies evaluating the effect of immunomodulatory drugs on the immunogenicity of the booster dose against COVID-19, indicating worsen response after GCs [ 30 ], biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) [ 15 , 30 ], and MTX [ 34 , 35 ].…”

“…There are only single studies evaluating the effect of immunomodulatory drugs on the immunogenicity of the booster dose against COVID-19, indicating worsen response after GCs [ 30 ], biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) [ 15 , 30 ], and MTX [ 34 , 35 ]. In our previous study, we assessed the effect of immunomodulatory drugs on humoral and cellular responses after the booster dose [ 36 ]. The humoral response after the booster dose was likewise in other studies only impaired by bDMARDs and tsDMARDs, but the cellular response was decreased after all immunomodulatory drugs except IL-17 inhibitors and sulfasalazine.…”

“…This is due to the lack of data regarding the kinetics of immunological response after the COVID-19 booster dose. Therefore, we continued the observation of the previously described cohort [ 36 ], aiming to assess the kinetics of humoral and cellular responses in IA patients after the booster dose of the COVID-19 vaccine.…”

The kinetics of humoral and cellular responses after the booster dose of COVID-19 vaccine in inflammatory arthritis patients

“…patients (6)(7)(8), also the immunogenicity of the booster dose is impaired in this group of patients (9)(10)(11)(12). In our previous study, we assessed humoral and cellular responses before the booster dose (more than 6 months from the primary vaccination schedule; T0) and 4 weeks after the booster dose (T1) in 49 IA patients and 47 HC vaccinated at the COVID-19 vaccination unit in a rheumatology center (13). Our study showed a boost of humoral and cellular responses in IA patients, but lower than in HC.…”