Humoral and cellular immunogenicity to a second dose of COVID-19 vaccine BNT162b2 in people receiving methotrexate or targeted immunosuppression: a longitudinal cohort study

Mahil, Satveer K.; Bechman, Katie; Raharja, Antony; Domingo‐Vila, Clara; Baudry, David; Brown, Matthew A.; Cope, Andrew; Dasandi, Tejus; Graham, Carl; Khan, Hataf; Lechmere, Thomas; Malim, Michael H.; Meynell, Freya; Pollock, Emily; Sychowska, Kamila; Barker, Jonathan; Norton, Sam; Galloway, James; Doores, Katie J.; Tree, Timothy; Smith, Catherine

doi:10.1016/s2665-9913(21)00333-7

Cited by 70 publications

(88 citation statements)

References 30 publications

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“…Patients receiving these biological DMARDs were able to develop cellular immune responses after vaccination with the BNT162b2 vaccine, and the overall humoral and cellular immune response did not differ significantly between patients and healthy individuals. By contrast to the data presented by Mahil and colleagues, 3 , 5 our findings did not indicate a significant disparity between humoral and cellular immune responses in individual patients. However, although all study participants had high levels of anti-SARS-CoV-2-specific IgA and IgG antibodies, cellular responses against the SARS-CoV-2 spike glycoprotein could not be identified in all participants.…”

contrasting

confidence: 99%

“… 2 Throughout the COVID-19 pandemic, patients receiving immunosuppressive treatment were shown to be at higher risk of severe disease outcomes. 3 Vaccination could prevent these outcomes, but the efficacy of COVID-19 vaccines in these patients is incompletely understood. 4 …”

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confidence: 99%

“… 6 , 8 For that reason, more data on vaccine-elicited SARS-CoV-2-reactive T cells in patients treated with biological DMARDs are urgently needed. Recent studies by Mahil and colleagues 3 , 5 show encouraging results on COVID-19 vaccine immunogenicity in patients with psoriasis treated with biological DMARDs. These studies showed that patients receiving these drugs were able to mount both serological and cellular responses to both the first and second dose of the BNT162b2 (tozinameran, Pfizer–BioNTech) mRNA vaccine.…”

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confidence: 99%

“…These studies showed that patients receiving these drugs were able to mount both serological and cellular responses to both the first and second dose of the BNT162b2 (tozinameran, Pfizer–BioNTech) mRNA vaccine. 3 , 5 …”

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confidence: 99%

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Humoral and cellular immune responses to mRNA COVID-19 vaccines in patients with axial spondyloarthritis treated with adalimumab or secukinumab

Smetanová

Střížová

Šedivá

et al. 2022

The Lancet Rheumatology

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Humoral and cellular immune responses to mRNA COVID-19 vaccines in patients with axial spondyloarthritis treated with adalimumab or secukinumab

Smetanová

Střížová

Šedivá

et al. 2022

The Lancet Rheumatology

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“…Studies on the effect of vaccination in rheumatic patients with arthritis, connective tissue diseases, vasculitis and PsA have demonstrated a low level of neutralizing antibodies to SARS-CoV-2 compared to the general population (13)(14)(15). In particular, it has been reported that methotrexate impairs serological response SARS-CoV-2 vaccine-induced immunity, even in absence of significant impact on seroconversion rate (16)(17)(18), while TNF-α inhibitors seems not to affect the ability to mount a sufficient serological and cellular response to two doses of SARS-CoV-2 mRNA BNT162b2 vaccine in psoriasis patients (17). Moreover, according to recent evidence, anti-IL17 and secukinumab, in particular, do not seem to interfere significantly with seroconversion rate following mRNA SARS-CoV-2 vaccine also (15,17,19).…”

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confidence: 99%

Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

et al. 2022

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BackgroundA few studies on vaccination in patients with rheumatic diseases, including arthritis, connective tissue diseases, vasculitis, and psoriatic arthropathy (PsA), demonstrated reduced production of neutralizing antibodies to SARS-CoV-2 Spike RBD (receptor-binding domain contained in the N-terminal of the S1 globular head region) when compared to the general population.ObjectiveThe aim of our study was to observe whether different therapies for PsA [methotrexate, anti-TNF antibodies, soluble TNF receptor (etanercept) or IL-17 inhibitors] have a different impact on SARS-CoV-2 vaccination in a homogeneous population of patients.MethodsWe enrolled 110 PsA patients in remission, assessed with Disease Activity in PSoriatic Arthritis (DAPSA). Of these: 63 were in treatment with anti-TNF-α therapy (26 etanercept, 15 certolizumab, 5 golimumab, 17 adalimumab); 37 with anti-IL17 secukinumab; 10 with methotrexate. All patients underwent vaccination for SARS-CoV-2 with mRNA BNT162b2 vaccine. Assessment of absolute and percentage lymphocyte subsets and anti-SARS-CoV-2 Spike RBD IgG antibody value 3 weeks after the second vaccine dose were performed. In addition, the serum antibody levels of 96 healthy healthcare workers (HCW) were analyzed.ResultsThe mean disease activity assessed with DAPSA score was 2.96 (SD = 0.60) with no significant differences between patients under different medications (p = 0.779). Median levels of neutralizing antibodies to SARS-CoV-2 Spike RBD were 928.00 binding antibody unit (BAU)/mL [IQR 329.25, 1632.0]; 1068.00 BAU/ml [IQR 475.00, 1632.00] in patients taking MTX, 846.00 BAU/ml [IQR 125.00, 1632.00] in patients taking etanercept, 908.00 BAU/mL [IQR 396.00, 1632.00] in patients taking anti-IL17 and 1148.00 BAU/ml [IQR 327.00, 1632.00] in patients taking TNF-α inhibitors, without statistically significant differences between these groups. Mean serum antibody level of HCW group was 1562.00 BAU/ml [IQR 975.00, 1632.00], being significantly higher than in the patient group (p = 0.000816). Absolute and percentage count of lymphocyte subsets were not statistically different between the subgroups under different treatments and when compared with HCW.ConclusionsAs for other rheumatic diseases on immunomodulatory treatment, our data showed a reduced humoral response in PsA patients compared to the control group. However, antibody response did not significantly differ between groups treated with different medications.

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Duration of Postvaccination Neutralizing Antibodies to SARS‐CoV‐2 and Medication Effects: Results from the Safety and Immunogenicity of COVID‐19 Vaccination in Systemic Immune‐Mediated Inflammatory Diseases Cohort Study

Habib,

Dayam,

Hitchon

et al. 2024

ACR Open Rheumatology

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ObjectiveIn the face of the ongoing circulation of SARS‐CoV‐2, the durability of neutralization post–COVID‐19 vaccination in immune‐mediated inflammatory disease (IMID) is a key issue, as are the effects of medications.MethodsAdults (n = 112) with inflammatory bowel disease, psoriasis/psoriatic arthritis, rheumatoid arthritis, spondylarthritis, and systemic lupus were recruited from participating Canadian medical centers from 2021 to 2023. We focused on log‐transformed neutralization (lentivirus methods) as a continuous outcome, with separate models for wild‐type and Omicron strains BA.1 and BA.5.ResultsCompared with 30 to 120 days postvaccination, subsequent periods were associated with greater neutralization in unadjusted models for wild‐type, BA.1, and BA.5 strains and against the BA.1 strain in adjusted models. Rituximab was associated with lower neutralization for the BA.1 strain in adjusted models, with a similar trend for BA.5. In methotrexate users, there were trends for less neutralization of BA.1 and BA.5 in all unadjusted models, whereas in adjusted models, there was significantly lower neutralization only for the wild type. Three or more doses and Omicron‐specific vaccines were both independently associated with better neutralization ability for all three strains. A COVID‐19 infection within six months before sampling was associated with higher neutralization of wild type and BA.1 in adjusted analyses. Anti–tumor necrosis factor agents were associated with lower neutralization ability for BA.5 in adjusted analyses.ConclusionNeutralization responses in immunosuppressed individuals with IMID were durable over time and were augmented by more than three doses and Omicron‐specific vaccines. Less neutralization was seen with certain medications. Our work clarifies the joint effects of vaccine history, infection, and medications on COVID‐19 immunity.

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Humoral and cellular immunogenicity to a second dose of COVID-19 vaccine BNT162b2 in people receiving methotrexate or targeted immunosuppression: a longitudinal cohort study

Cited by 70 publications

References 30 publications

Humoral and cellular immune responses to mRNA COVID-19 vaccines in patients with axial spondyloarthritis treated with adalimumab or secukinumab

Humoral and cellular immune responses to mRNA COVID-19 vaccines in patients with axial spondyloarthritis treated with adalimumab or secukinumab

Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response?

Duration of Postvaccination Neutralizing Antibodies to SARS‐CoV‐2 and Medication Effects: Results from the Safety and Immunogenicity of COVID‐19 Vaccination in Systemic Immune‐Mediated Inflammatory Diseases Cohort Study

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