Serologic Screening for Coronavirus Disease 2019 in Patients With Glomerular Disease

Turner‐Stokes, Tabitha; Jiang, Elina; Johnson, Nathan; Khakhria, Kanay; Kong, Edmund; Cairns, Tom; Clarke, Candice; Greathead, Louise; Griffith, Megan; Guckian, Mary; Kelleher, Peter; McClure, Myra O.; Prendecki, Maria; Rosadas, Carolina; Tedder, Richard S.; Lightstone, Liz; Willicombe, Michelle; McAdoo, Stephen P.

doi:10.1016/j.ekir.2021.02.006

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…All 69 patients who were B-cell deplete had received treatment with rituximab, 69.6% (48/69) within the last 6 months. Nineteen patients (13.6%) had evidence of previous SARS-CoV-2 infection on baseline testing—in keeping with the low prevalence of disease previously described in our cohort16—and these were analysed separately from those who were infection-naive. Two further patients developed anti-NP IgG after vaccination, indicating SARS-CoV-2 infection at or since vaccination and were excluded from analysis.…”

Section: Resultsmentioning

confidence: 91%

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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 91%

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

et al. 2021

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“…Asymptomatic or mild cases of COVID-19 were not well represented in these early registry data as PCR testing was generally limited to hospital settings [10 ▪▪ ,11 ▪▪ ]. To address this important bias, we used systematic serological testing in our large cohort of patients with glomerular disease to identify all those with evidence of previous SARS-CoV-2 infection, facilitating a more representative analysis of COVID-19 severity [14]. Of 493 patients screened, 7.5% had serological evidence of previous SARS-CoV-2 infection.…”

Section: Covid-19 In Patients With Glomerular Diseasementioning

confidence: 99%

COVID-19 in patients with glomerular disease

Turner‐Stokes

Edwards

Lightstone

2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewManaging patients with glomerular disease during the COVID-19 pandemic has been challenging, as the infection risk associated with immunosuppression must be balanced against the need to control severe glomerular disease that can lead to kidney failure. This review provides an overview of COVID-19 and the effectiveness of SARS-CoV-2 vaccination in patients with glomerular disease. Recent findingsRegistry data, although biased towards outcomes of hospitalized patients, suggest that the mortality from COVID-19 is higher in patients with glomerular disease than in the general population. Glucocorticoid use prior to SARS-CoV-2 infection is associated with adverse outcomes from COVID-19. Rituximab significantly attenuates serological responses to both natural infection and vaccination against SARS-CoV-2, although it is not clear whether this leads to adverse outcomes. Case reports of disease flares occurring after vaccination have been reported, but causality in any of these cases has yet to be proven and the absolute risk remains very small. SummaryPatients with glomerular disease represent an at-risk group for severe COVID-19 disease and vaccination is key to reducing this risk. As immunosuppressed patients demonstrate an attenuated response to vaccination, the efficacy of a third primary dose followed by a subsequent booster is being investigated.

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Association of COVID-19 Versus COVID-19 Vaccination With Kidney Function and Disease Activity in Primary Glomerular Disease: A Report of the Cure Glomerulonephropathy Study

Wang¹,

Glenn²,

Helmuth³

et al. 2024

American Journal of Kidney Diseases

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Serologic Screening for Coronavirus Disease 2019 in Patients With Glomerular Disease

Cited by 3 publications

References 9 publications

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

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

COVID-19 in patients with glomerular disease

Association of COVID-19 Versus COVID-19 Vaccination With Kidney Function and Disease Activity in Primary Glomerular Disease: A Report of the Cure Glomerulonephropathy Study

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