Third dose of anti-SARS-CoV-2 inactivated vaccine for patients with RA: Focusing on immunogenicity and effects of RA drugs

Abstract

ObjectivesTo evaluate the immunogenicity of the third dose of inactivated SARS-CoV-2 vaccine in rheumatoid arthritis (RA) patients and explore the effect of RA drugs on vaccine immunogenicity.MethodsWe recruited RA patients (n = 222) and healthy controls (HC, n = 177) who had been injected with a third dose of inactivated SARS-CoV-2 vaccine, and their neutralizing antibody (NAb) titer levels were assessed.ResultsRA patients and HC were age- and gender-matched, and the mean interval between 3rd vaccination and sampling was comparable. The NAb titers were significantly lower in RA patients after the third immunization compared with HC. The positive rate of NAb in HC group was 90.4%, while that in RA patients was 80.18%, and the difference was significant. Furthermore, comparison of NAb titers between RA treatment subgroups and HC showed that the patients in the conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) group exhibited no significant change in NAb titers, while in those receiving the treatment of biological DMARDs (bDMARDs), Janus Kinase (JAK) inhibitors, and prednisone, the NAb titers were significantly lower. Spearman correlation analysis revealed that NAb responses to SARS-CoV-2 in HC did differ significantly according to the interval between 3rd vaccination and sampling, but this finding was not observed in RA patients. In addition, NAb titers were not significantly correlated with RA-related laboratory indicators, including RF-IgA, RF-IgG, RF-IgM, anti-CCP antibody; C-RP; ESR; NEUT% and LYMPH%.ConclusionSerum antibody responses to the third dose of vaccine in RA patients were weaker than HC. Our study will help to evaluate the efficacy and safety of booster vaccination in RA patients and provide further guidance for adjusting vaccination strategies.

Managing Patients with Immune-Mediated Inflammatory Diseases on Disease-Modifying Antirheumatic Drug Therapy in a COVID-19 Endemic World: A Narrative Review and Expert Insights

“…These findings were supported by data from a Chinese cohort study involving RA patients, which showed that patients treated with bDMARDs, JAKis and prednisone had significantly lower neutralizing antibody titers when compared with healthy controls [42]. However, no significant decrease was observed in RA patients treated with csDMARDs [42].…”

“…This reduction was attributed to a faster decline in antibody levels, indicating a significantly reduced duration of vaccination-induced immunity compared with healthy controls or patients receiving csDMARDs [41].Furthermore, there was a reduced response to booster vaccination, highlighting the need for earlier booster vaccination strategies based on specific antibody levels in patients under b/tsDMARD therapy [41]. These findings were supported by data from a Chinese cohort study involving RA patients, which showed that patients treated with bDMARDs, JAKis and prednisone had significantly lower neutralizing antibody titers when compared with healthy controls [42]. However, no significant decrease was observed in RA patients treated with csDMARDs [42].…”

The Kinetics of Humoral and Cellular Responses after the Booster Dose of COVID-19 Vaccine in Inflammatory Arthritis Patients

“…The abrogated immunological response to the primary vaccination schedule results in a faster decline of post-vaccination immunity in IA patients [ 5 , 7 , 16 , 18 , 25 , 26 ], making booster vaccinations among IA patients even more important than in HC. Current studies proved that, though COVID-19 booster vaccinations are effective in IA patients [ 27 , 28 , 29 ], also the immunogenicity of the booster dose is impaired in this group of patients [ 15 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. There are only single studies evaluating the effect of immunomodulatory drugs on the immunogenicity of the booster dose against COVID-19, indicating worsen response after GCs [ 30 ], biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) [ 15 , 30 ], and MTX [ 34 , 35 ].…”

“…Current studies proved that, though COVID-19 booster vaccinations are effective in IA patients [ 27 , 28 , 29 ], also the immunogenicity of the booster dose is impaired in this group of patients [ 15 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. There are only single studies evaluating the effect of immunomodulatory drugs on the immunogenicity of the booster dose against COVID-19, indicating worsen response after GCs [ 30 ], biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) [ 15 , 30 ], and MTX [ 34 , 35 ]. In our previous study, we assessed the effect of immunomodulatory drugs on humoral and cellular responses after the booster dose [ 36 ].…”

The kinetics of humoral and cellular responses after the booster dose of COVID-19 vaccine in inflammatory arthritis patients

“…CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. patients (6)(7)(8), also the immunogenicity of the booster dose is impaired in this group of patients (9)(10)(11)(12). In our previous study, we assessed humoral and cellular responses before the booster dose (more than 6 months from the primary vaccination schedule; T0) and 4 weeks after the booster dose (T1) in 49 IA patients and 47 HC vaccinated at the COVID-19 vaccination unit in a rheumatology center (13).…”