Humoral and cellular response to COVID-19 vaccination in patients with autoimmune inflammatory rheumatic diseases under real-life conditions

Abstract

Objectives Successful vaccination is key to overcoming the COVID-19 pandemic. Immunosuppressive medication is known to potentially compromise vaccination responses, and expansion of our knowledge on vaccination efficacy in patients with autoimmune inflammatory rheumatic diseases (AIIRD) is therefore of utmost importance. Methods We conducted a single-centre observational study and evaluated the efficacy of approved COVID-19 vaccines in 303 adult AIIRD patients. Serum levels of IgG antibodies against the S1 subunit of SARS-CoV-2 spike proteins (anti-S IgG) were measured at least two weeks after vaccination. In a subgroup of patients without humoral response, T cell responses were determined using an interferon-γ gamma release assay. Results Overall seropositivity rate was 78.5% and was significantly lower in patients under immunosuppressive therapy (75.7 vs. 93.2%, p = 0.009). No difference regarding the vaccination type was observed. Glucocorticoids, mycophenolate-mofetil, TNF inhibitors, tocilizumab, abatacept and rituximab were all associated with non-response after proper vaccination. The risk was highest under RTX therapy (OR 0.004, 95%CI0.001-0.023, p < 0.0001). A strong negative correlation was observed between time since vaccination with an mRNA vaccine and anti-S antibody levels (r=-0.6149, p < 0.0001). In patients without humoral response, a T cell response was found in 50%. Conclusions COVID-19 vaccination in patients with AIIRD is effective using any approved vaccine. Humoral response might be impaired depending on the individual immunosuppressive medication. The risk of non-response is highest under rituximab therapy. Anti-S IgG antibody levels wane over time after mRNA vaccination. Importantly, 50% of humoral non-responders showed a T cellular response, suggesting T cell-mediated protection to a certain extent.

Complete (Humoral and Cellular) Response to Vaccination against COVID-19 in a Group of Healthcare Workers-Assessment of Factors Affecting Immunogenicity

“…Medications taken were not analysed. This may have influenced the underestimation of reported comorbidities with a significant impact on the response to vaccination [ 38 , 39 , 40 ].…”

Impaired Neutralizing Antibody Activity against B.1.617.2 (Delta) after Anti-SARS-CoV-2 Vaccination in Patients Receiving Anti-CD20 Therapy

“…Rasselt et al showed that Rituximab administration was particularly frequently associated with a lack of seroconversion (90%), whereas Mycophenolate-mofetil (25%) had a lesser impact. However, additional negative effects of immunosuppressive co-medication should not be neglected [ 24 ]. B-cell repopulation and time between last Rituximab treatment prior to vaccination seems to be crucial as König et al and others demonstrated [ 25 , 26 ].…”

Immunogenicity 6 months post COVID-19 mRNA vaccination among adolescents with juvenile idiopathic arthritis on treatment with TNF inhibitors

“…Only 62% of patients with RMDs on treatment with MTX achieved adequate antibody production post immunization, whereas those on TNFi demonstrated an immune response similar to that of the healthy controls (>90%) [ 2 , 5 ]. In addition, it was found that not only humoral immunity, but cellular immunity is important for protection against COVID-19 [ 16 ].…”

“…On the contrary, treatment with rituximab has been related to more severe disease and adverse outcome [ 1 ]. In addition, patients on rituximab failed to mount a sufficient immunogenic response to the two-dose immunization scheme with the mRNA vaccines, hence current guidelines suggest either postponing immunization or administering vaccines prior to initiation of treatment [ 2 ]. Adherence to personal protection measures and mass vaccination were shown to be the two most effective strategies for controlling the COVID-19 pandemic [ 3 ].…”