Neutralizing SARS-CoV-2 antibody response in dialysis patients after the first dose of the BNT162b2 mRNA COVID-19 vaccine: the war is far from being won

Torreggiani, Massimo; Blanchi, Sophie; Fois, Antioco; Fessi, H.; Piccoli, Giorgina Barbara

doi:10.1016/j.kint.2021.04.010

Cited by 44 publications

(38 citation statements)

References 8 publications

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“…A two-dose regimen of BNT162b2 vaccine is 95% effective in preventing coronavirus disease 2019 (COVID-19) in the general population 6 . It was reported in recent case series of dialysis patients vaccinated with BNT162b2 that seroconversion occurred in almost all patients although the antibody titer was lower than in controls 7 , 8 , 9 , 10 , 11 , 12 , 13 . On this basis, it has been recommended by the French National Authority for Health (Haute Autorité de Santé) to systematically administer a third vaccine dose in dialysis patients 14 .…”

Section: Introductionmentioning

confidence: 78%

SARS-CoV-2 Antibody Response After a Third Dose of the BNT162b2 Vaccine in Patients Receiving Maintenance Hemodialysis or Peritoneal Dialysis

Bensouna¹,

Caudwell²,

Kubab³

et al. 2022

American Journal of Kidney Diseases

122

119

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Rationale & Objective Recent studies showed that antibody titers after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the dialysis population are diminished as compared to the general population, suggesting the possible value of a third booster dose. We aimed to characterize the humoral response after three doses of the BNT162b2 vaccine in patients treated with either maintenance hemodialysis (HD) or peritoneal dialysis (PD). Study Design Case series. Setting & Participants 69 French patients (38 HD and 31 PD) treated at a single center who received three doses of the BNT162b2 vaccine. Findings Humoral response was evaluated using plasma levels of anti-SARS-CoV-2 spike protein S1 immunoglobulin measured after the second dose and at least three weeks after the third dose of the BNT162b2 vaccine. Patients (median age 68 [IQR, 53-76] years, 65% men) had a median anti-S1 antibody level of 284 [IQR, 83-1190] AU/mL after the second dose, and 7554 [IQR, 2268-11736] AU/mL after the third dose. Three patients were non-responders (anti-S1 antibody level < 0.8 AU/mL) and 12 were weak responders (anti-S1 antibody level 0.8-50 AU/mL) after the second vaccine dose. After the third dose, one of the three initial non-responders produced anti-spike antibody and all the 12 initial weak responders increased their antibody levels. Patients with a greater increase in anti-S1 antibody levels after a third dose had lower antibody levels after the second dose, and a longer time interval between the second and the third dose. Adverse events did not seem to be more common or severe following a third vaccine dose. Limitations Observational study, small sample size. Relationship between antibody levels and clinical outcomes is not well understood. Conclusions A third dose of the BNT162b2 vaccine substantially increased antibody levels in patients receiving maintenance dialysis and appeared to be as well tolerated as a second dose.

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Section: Introductionmentioning

confidence: 78%

SARS-CoV-2 Antibody Response After a Third Dose of the BNT162b2 Vaccine in Patients Receiving Maintenance Hemodialysis or Peritoneal Dialysis

Bensouna¹,

Caudwell²,

Kubab³

et al. 2022

American Journal of Kidney Diseases

122

119

View full text Add to dashboard Cite

show abstract

“…A recent study reported that, as vaccination programs start to roll out, social distancing decreases due to the anticipated efficacy of SARS-CoV-2 vaccinations [ 6 ]. Recently, reduced antibody response after the first dose of mRNA-based COVID-19 vaccine in hemodialysis patients was briefly reported [ 7 ]. However, the effect of the first dose of a vector-based vaccine in hemodialysis patients remains unknown and peritoneal dialysis patients have not yet been investigated in this regard.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity of a first dose of mRNA- or vector-based SARS-CoV-2 vaccination in dialysis patients: a multicenter prospective observational pilot study

Lesny¹,

Anderson

Cloherty

et al. 2021

J Nephrol

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Background Dialysis patients are at risk for lower SARS-CoV-2-vaccine immunogenicity than the normal population. We assessed immunogenicity to a first mRNA- or vector-based SARS-CoV-2-vaccination dose in dialysis patients. Methods In a multicenter observational pilot study, 2 weeks after a first vaccination (BNT162b2/Pfizer-BioNTech [Comirnaty] or ChAdOx1 nCoV-19/Oxford-Astra-Zeneca [Vaxzevria]), hemodialysis patients (N = 23), peritoneal dialysis patients (N = 4) and healthy staff (N = 14) were tested for SARS-CoV-2-spike IgG/IgM, Nucleocapsid-protein-IgG-antibodies and plasma ACE2-receptor-binding-inhibition capacity. Hemodialysis patients who had had prior COVID-19 infection (N = 18) served as controls. Both response to first SARS-CoV-2 vaccination and IgG spike-positivity following prior COVID-19 infection were defined as SARS-CoV-2 spike IgG levels ≥ 50 AU/mL. Results Vaccination responder rates were 17.4% (4/23) in hemodialysis patients, 100% (4/4) in peritoneal dialysis patients and 57.1% (8/14) in staff (HD vs. PD: p = 0.004, HD vs. staff: p = 0.027). Among hemodialysis patients, type of vaccine (Comirnaty N = 11, Vaxzevria N = 12, 2 responders each) did not appear to influence antibody levels (IgG spike: Comirnaty median 0.0 [1.–3. quartile 0.0–3.8] versus Vaxzevria 4.3 [1.6–20.1] AU/mL, p = 0.079). Of responders to the first dose of SARS-CoV-2 vaccination among hemodialysis patients (N = 4/23), median IgG spike levels and ACE2-receptor-binding-inhibition capacity were lower than that of IgG spike-positive hemodialysis patients with prior COVID-19 infection (13/18, 72.2%): IgG spike: median 222.0, 1.–3. quartile 104.1–721.9 versus median 3794.6, 1.–3. quartile 793.4–9357.9 AU/mL, p = 0.015; ACE2-receptor-binding-inhibition capacity: median 11.5%, 1.–3. quartile 5.0–27.3 versus median 74.8%, 1.–3. quartile 44.9–98.1, p = 0.002. Conclusions Two weeks after their first mRNA- or vector-based SARS-CoV-2 vaccination, hemodialysis patients demonstrated lower antibody-related response than peritoneal dialysis patients and healthy staff or unvaccinated hemodialysis patients following prior COVID-19 infection. Graphic abstract

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“…Younger age has also been associated with antibody response. A study of 101 vaccinated in-center hemodialysis patients by Torreggiani et al reported that the age of neutralizing SARS-CoV-2 antibody responders was significantly lower than that of non-responders [ 49 ]. Frantzen et al studied 244 in-center hemodialysis patients who received the two-dose BNT162b2 vaccination and observed that the younger patients were more likely to have an antibody response [ 50 ].…”

Section: Effectiveness Of Covid-19 Vaccines In Hemodialysis Patientsmentioning

confidence: 99%

COVID-19 Vaccines in Patients with Maintenance Hemodialysis

Yen

Lin

Chen

et al. 2021

JPM

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The COVID-19 pandemic has infected more than 180 million people and caused more than 3.95 million deaths worldwide. In addition to personal hygiene, augmented cleaning, social distancing, and isolation, vaccine development and immunization are essential for this highly contagious disease. Patients with maintenance hemodialysis (MHD) have a greater risk of COVID-19 infection owing to their comorbidities, defective immunity, and repeated crowded in-center dialysis settings. However, many patients hesitate to get vaccinated because of their misunderstandings. The Efficacy of COVID-19 vaccination has been intensively discussed in the general population, whereas the data concerning the effectiveness of vaccination in MHD patients are relatively scanty. Nevertheless, those limited publications can provide some valuable information. Overall, lower and more delayed antibody responses following COVID-19 vaccination were observed in patients with MHD than in healthy controls in the settings of different populations, vaccines and dosage, definitions of the immune response, and antibody detection timepoints. Younger age, previous COVID-19 infection, and higher serum albumin level were positively associated with antibody formation, whereas older age and receiving immunosuppressive therapy were unfavorable factors. However, it remains uncertain between the elicited antibodies following vaccination and the genuine protection against COVID-19 infection. Patients with MHD should make their COVID-19 vaccination a priority in addition to other protective measures. More studies focusing on different vaccines, non-humoral immune responses, and risk-benefit analyses are warranted.

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Neutralizing SARS-CoV-2 antibody response in dialysis patients after the first dose of the BNT162b2 mRNA COVID-19 vaccine: the war is far from being won

Cited by 44 publications

References 8 publications

SARS-CoV-2 Antibody Response After a Third Dose of the BNT162b2 Vaccine in Patients Receiving Maintenance Hemodialysis or Peritoneal Dialysis

SARS-CoV-2 Antibody Response After a Third Dose of the BNT162b2 Vaccine in Patients Receiving Maintenance Hemodialysis or Peritoneal Dialysis

Immunogenicity of a first dose of mRNA- or vector-based SARS-CoV-2 vaccination in dialysis patients: a multicenter prospective observational pilot study

COVID-19 Vaccines in Patients with Maintenance Hemodialysis

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