Immunogenicity and Safety of SARS-CoV-2 Vaccination in Patients With Rheumatic Diseases: A Systematic Review and Meta-analysis

Abstract

Background: Patients with rheumatic disease (RD) are at increased risk for COVID-19 infection. Large clinical trials have demonstrated efficacy and safety of SARS-CoV-2 vaccine. However, patients with RD are typically excluded from these trials. Objective:The aim of this study was to conduct a systematic review and meta-analysis examining the immunogenicity and safety of SARS-CoV-2 vaccination in patients with RD. Methods:We systematically searched PubMed/MEDLINE and Scopus to identify observational studies that examined the immunogenicity and safety of SARS-CoV-2 vaccination in RD patients. Information on disease, immunosuppressant, vaccine type, and proportion of patients with serologic response was obtained from each study.Results: There were 25 eligible studies. The pooled rate of seroconversion was 0.79 (95% confidence interval [CI], 0.72-0.86). Compared with control subjects, the odds of seroconversion were significantly lower (odds ratio, 0.11; 95% CI, 0.05-0.24). Users of rituximab showed the lowest rate of seroconversion (0.39; 95% CI, 0.29-0.51) followed by mycophenolate (0.56; 95% CI, 0.40-71). On the other hand, users of interleukin 17 (0.94; 95% CI, 0.78-0.98) and tumor necrosis factor inhibitors (0.94; 95% CI, 0.84-0.98) showed high seroconversion rate. Regarding safety of COVID-19 vaccine, approximately 2% of patients reported severe adverse events and 7% reported diseases flares following the first or second dose. Conclusion:Vaccination against SARS-CoV-2 appears to be safe. Most RD patients developed humoral immune response following vaccination. However, the odds of seroconversion were significantly lower in RD patients compared with controls. This is likely driven by certain immunosuppressants including rituximab and mycophenolate. Future studies need to identify strategies to improve vaccine response in these patients.

Immunogenicity, Effectiveness, and Safety of COVID-19 Vaccines among Patients with Immune-Mediated Dermatological Diseases: A Systematic Review and Meta-analysis

“…As most of the included studies investigated immune responses in psoriasis patients, this is consistent with our findings that the pooled seroconversion rate was comparable between groups. However, this result is somewhat contradictory to previous studies conducted in immune-mediated inflammatory disease and inflammatory bowel disease patients, where inferior immunological responses were demonstrated ( 12 , 15 , 38 – 40 ). This may be due to more aggressive treatment regimens for immune-mediated diseases of other organs compared with the skin.…”

“…Our results also showed that IMDD patients receiving immunosuppressive drugs had a lower anti-SARS-CoV-2 IgG level than HCs. This is consistent with prior studies of immunosuppressed patients taking rituximab, mycophenolate, azathioprine, and glucocorticoids ( 15 , 16 , 38 ). However, one should be cautious that the same medications may not exert the same degree of immunosuppression in different diseases.…”

Janus kinase (JAK) inhibitors significantly reduce the humoral vaccination response against SARS-CoV-2 in patients with rheumatoid arthritis

“…Initial studies on this topic have shown a strong dependence of the vaccination response on the underlying DMARD therapy [3]. Glucocorticoids, mycophenolate, abatacept, and especially rituximab seem to be associated with a particularly strong attenuation of the humoral response [4].…”

Benefits of Switching Mycophenolic Acid to Sirolimus on Serological Response after a SARS-CoV-2 Booster Dose among Kidney Transplant Recipients: A Pilot Study

“…Fifty-seven percent of SOTRs with antimetabolites (mycophenolic acid or azathioprine) had negative antibody response after two doses of mRNA vaccine compared to 18% of those without antimetabolites [ 2 ]. A recent meta-analysis in patients with rheumatic diseases revealed that using MPA reduced the rate of seroconversion after SARS-CoV-2 vaccination by 44% [ 22 ].…”