Humoral and T-cell responses to SARS-CoV-2 vaccination in patients receiving immunosuppression

Abstract

ObjectiveThere is an urgent need to assess the impact of immunosuppressive therapies on the immunogenicity and efficacy of SARS-CoV-2 vaccination.MethodsSerological and T-cell ELISpot assays were used to assess the response to first-dose and second-dose SARS-CoV-2 vaccine (with either BNT162b2 mRNA or ChAdOx1 nCoV-19 vaccines) in 140 participants receiving immunosuppression for autoimmune rheumatic and glomerular diseases.ResultsFollowing first-dose vaccine, 28.6% (34/119) of infection-naïve participants seroconverted and 26.0% (13/50) had detectable T-cell responses to SARS-CoV-2. Immune responses were augmented by second-dose vaccine, increasing seroconversion and T-cell response rates to 59.3% (54/91) and 82.6% (38/46), respectively. B-cell depletion at the time of vaccination was associated with failure to seroconvert, and tacrolimus therapy was associated with diminished T-cell responses. Reassuringly, only 8.7% of infection-naïve patients had neither antibody nor T-cell responses detected following second-dose vaccine. In patients with evidence of prior SARS-CoV-2 infection (19/140), all mounted high-titre antibody responses after first-dose vaccine, regardless of immunosuppressive therapy.ConclusionSARS-CoV-2 vaccines are immunogenic in patients receiving immunosuppression, when assessed by a combination of serology and cell-based assays, although the response is impaired compared with healthy individuals. B-cell depletion following rituximab impairs serological responses, but T-cell responses are preserved in this group. We suggest that repeat vaccine doses for serological non-responders should be investigated as means to induce more robust immunological response.

Temporal metabolic response to mRNA COVID-19 vaccinations in oncology patients

“…While vaccine-induced lymphadenopathy has been described with other vaccines such as influenza [ 3 , 4 ], vaccine-induced lymphadenopathy appears to be more prominent with mRNA COVID-19 vaccines. The mRNA COVID-19 vaccines are reported to be more immunogenic than traditional vaccines [ 5 ], which may influence the extent and duration of vaccine-induced lymphadenopathy on imaging. Recent literature has shed light on the confounding effects of vaccine-induced lymphadenopathy and proposed timelines for consideration of performing PET/CT examinations in relation to COVID-19 vaccine administration.…”

Additional heterologous versus homologous booster vaccination in immunosuppressed patients without SARS-CoV-2 antibody seroconversion after primary mRNA vaccination: a randomized controlled trial

“…Patients under immunosuppressive therapy with rituximab, a B-cell-depleting monoclonal antibody against the CD20 surface antigen, are at a high risk for severe COVID-19 requiring hospitalization and ICU admission 10,11 . At the same time, B-cell depletion reduces immune responses to vaccination 12,13 . This combination poses a dilemma and therefore a highly unmet clinical need for this group of patients.…”

Immune Responses against SARS-CoV-2—Questions and Experiences

“…This analysis is useful for determining previous exposure to SARS-CoV-2 and is fundamental to evaluate protection against reinfection or the response to vaccine in elderly or immunocompromised patients. It has been demonstrated the B-cell depletion following rituximab treatment impairs serological responses, while T-cell responses were preserved [92]. Further, cellular immune responses were not attenuated in patients receiving methotrexate or targeted biologics compared with controls [93].…”