Humoral response to Pfizer mRNA vaccine against SARS CoV2, in patients with autoimmune inflammatory rheumatic diseases and the impact on the rheumatic disease activity

Abstract

Background: The registration trials of mRNA vaccines against SARS CoV2 did not address patients with autoimmune inflammatory rheumatoid diseases (AIRD). Aims: To assess the humoral response to mRNA vaccine against SARS CoV2, in AIRD patients treated with immunomodulating drugs and the impact on AIRD activity. Methods: Consecutive patients treated at the rheumatology institute who received their first SARS-CoV-2 (Pfizer) vaccine were recruited to the study, at their routine visit. The patients were invited for serology test 4-6 weeks after receiving the second dose of vaccine. IgG Antibodies (Ab) against SARS COV2 virus were detected using the SARS-Cov-2 IgG II Quant (Abbott) assay Results: One hundred fifty-six consecutive patients (76% females) treated at a single rheumatology center (mean age (range) 59.1 (21-83) years), mean (range) disease duration 10.8 (1-55) years), were recruited to the study. Thirty-five percents of patients received conventional synthetic (cs)DMARDs only, 64% biological/targeted synthetic (b/ts) DMARDs, 34% received combined treatment with csDMARDs and b/tsDMARDs and 32% corticosteroids (mean dose(range) 5.8mg(2.5-20mg) prednisone). One hundred thirty-seven patients (88%) were seropositive for IgG Ab against SARS CoV2 virus (median 2832.5 AU/ml, range 58-29499). Nineteen (12%) patients had negative tests, 11/19 were treated with B cell depleting agents. The reported side effects of the vaccine were minor (muscle sore, headache, low grade fever). The rheumatic disease remained stable in all patients. Conclusions: The vast majority of AIRD patients developed a significant humoral response following the administration of the second dose of the Pfeizer mRNA vaccine against SARS CoV2 virus. Only minor side effects were reported and no apparent impact on AIRD activity was noted.

Antibody response to inactivated COVID-19 vaccine (CoronaVac) in immune-mediated diseases: a controlled study among hospital workers and elderly

“…Our results are in line with the recent literature [ 19 – 24 ]. Reduced antibody titers and negative effect of DMARDs among patients with IMD were reported in the majority of the studies investigating mRNA vaccine response.…”

“…Antibody response to vaccine against SARS-CoV-2 in patients with IMD or patients on immunosuppression has been investigated in a few studies recently [ 19 – 24 ] and notably in all, mRNA vaccine was studied. To our knowledge, ours is the first with chemically inactivated vaccine (CoronaVac).…”

Humoral and cellular responses to mRNA vaccines against SARS-CoV-2 in patients with a history of CD20 B-cell-depleting therapy (RituxiVac): an investigator-initiated, single-centre, open-label study

“…Our report adds to the results of a series of studies that have investigated humoral and cellular responses to SARS-CoV-2 vaccination in patients with a history of B-cell depleting anti-CD20 therapies. 11 , 12 , 16 , 28 , 29 , 30 , 31 Deepak and colleagues 11 first reported a 36-fold decrease in vaccine-induced anti-spike IgG titres in patients with B-cell depleting therapies. Simon and colleagues 30 and Apostolidis and colleagues 29 reported no detectable or severely diminished vaccine-induced humoral immune responses compared with controls in two smaller series of patients with severely depleted B-cell counts, but both studies reported detectable cell-mediated immunity in these patients.…”

“… 10 There is an urgent need for evidence-based recommendations for administration of SARS-CoV-2 vaccines in immunocompromised patients, since in the absence of randomised controlled trials, current recommendations to delay B-cell-depleting therapies are based on previous influenza vaccination studies 7 and emerging humoral data on immune responses to SARS-CoV-2 vaccines in immunocompromised patients. 11 , 12 , 13 , 14 , 15 , 16 An improved understanding of humoral and cell-mediated responses following vaccination against SARS-CoV-2 in patients treated with anti-CD20-depleting agents is a prerequisite for the development of individualised vaccination strategies for this population. Notably, longitudinal observational data after SARS-CoV-2 infection and after mRNA vaccine administration has provided evidence that, in COVID-19 and after vaccination, cell-mediated immune responses were crucial for humoral immunity 17 , 18 , 19 , 20 , 21 and might provide protection even in patients with B-cell depletion.…”

Humoral and cellular responses to mRNA vaccines against SARS-CoV2 in patients with a history of CD20-B-cell depleting therapy

“…Our report adds novelty to the results of a series of smaller studies that have previously investigated humoral and cellular responses to SARS-CoV2 vaccination of patients with a history of B-cell depleting anti-CD20 therapies 11,12,16,29,30 .…”