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Meta-Analysis
. 2022 Jan;21(1):102927.
doi: 10.1016/j.autrev.2021.102927. Epub 2021 Aug 30.

Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: Systematic review and meta-analysis

Anuraag Jena  1 , Shubhra Mishra  1 , Parakkal Deepak  2 , Praveen Kumar-M  3 , Aman Sharma  4 , Yusuf I Patel  5 , Nicholas A Kennedy  6 , Alfred H J Kim  7 , Vishal Sharma  8 , Shaji Sebastian  9
Affiliations
Meta-Analysis

Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: Systematic review and meta-analysis

Anuraag Jena et al. Autoimmun Rev. 2022 Jan.

Abstract

Objectives: The treatment for COVID-19 often utilizes immune-modulating drugs. These drugs are also used in immune mediated inflammatory diseases (IMIDs). We performed a systematic review about seroconversion after SARS-CoV-2 vaccination in patients with IMIDs and impact of various drugs on seroconversion rates.

Methods: Electronic databases were searched to identify relevant studies reporting seroconversion rates following SARS-CoV-2 vaccination in IMIDs. We calculated the pooled seroconversion rates after a single or two doses of vaccination, pooled seroconversion rates in patients with specific IMIDs, and rates in patients on various drugs/drug classes.

Results: Twenty-five studies were included in the systematic review. The pooled seroconversion rates after two doses of mRNA vaccination were higher (83.1, 95%CI: 74.9-89.0, I2 = 90%) as compared to a single dose (69.3, 52.4-82.3, I2 = 95%). The odds of seroconversion were lower in IMIDs as compared to healthy controls (0.05, 0.02-0.13, I2 = 21%). The seroconversion rates in patients with inflammatory bowel disease (95.2, 95%CI: 92.6-96.9, I2 = 0%), spondyloarthropathy (95.6, 95% CI: 83.4-98.9, I2 = 35%), and systemic lupus erythematosus (90.7, 95%CI: 85.4-94.2, I2 = 0%) were higher as compared to rheumatoid arthritis (79.5, 95% CI: 65.1-88.9, I2 = 85%), and vasculitis (70.5, 95% CI: 52.9-83.5, I2 = 51%). The seroconversion rates following double dose of mRNA were excellent (>90%) in those on anti-tumour necrosis factor (TNF), anti-integrin (vedolizumab), anti-IL 17 (secukinumab), anti-IL6 (Tocilizumab) and anti-IL12/23 (Ustekinumab) therapies but attenuated (<70%) in patients on anti-CD20 (Rituximab) or anti-cytotoxic T lymphocyte associated antigen (CTLA-4) therapies (Abatacept). The seroconversion rates were good (70-90%) with steroids, hydroxychloroquine, JAK inhibitors, mycophenolate mofetil and leflunomide. Combination of anti-TNF with immunomodulators (azathioprine, 6-meracptopurine, methotrexate) resulted in an attenuated vaccine response as compared to anti-TNF monotherapy.

Conclusion: Seroconversion rates after SARS-CoV-2 vaccination are lower in patients with IMIDs. Certain therapies (anti-TNF, anti-integrin, anti-IL 17, anti-IL6, anti-12/23) do not impact seroconversion rates while others (anti-CD20, anti-CTLA-4) result in poorer responses.

Keywords: Adenoviral associated; COVID-19; Immunization; Inflammatory bowel disease; Rheumatoid arthritis; Spondyloarthropathy; Systemic lupus erythematosus; Vasculitis.

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Conflict of interest statement

None.

PD has served as a consultant or on an advisory board for Janssen, Pfizer, Prometheus Biosciences, Boehringer Ingelheim, AbbVie, Arena Pharmaceuticals and Scipher Medicine Corporation. He has also received funding under a sponsored research agreement unrelated to the data in the paper from Takeda Pharmaceutical, Arena Pharmaceuticals, Bristol Myers Squibb-Celgene, and Boehringer Ingelheim.

AHJK participated in advisory boards and educational speaker events for Exagen Diagnostics Inc. and Aurinia Pharmaceuticals Inc., research grant, advisory boards, and educational speaker events for GlaxoSmithKline, advisory boards for Alexion Pharmaceuticals Inc., and consulting work for Annexon Biosciences.

SS holds research grants from Biogen, Takeda, Pfizer, Janssen,AbbVie, Tillotts Pharma, Ferring and Biohit; served on the advisory boards of Takeda, AbbVie, Merck, Ferring, Pharmacocosmos, Warner Chilcott, Janssen, Falk Pharma, Biohit, TriGenix, Celgene and Tillots Pharma; and has received speaker fees from AbbVie, Takeda, Celltrion, Pfizer, Biogen, AbbVie, Janssen, Merck, Warner Chilcott and Falk Pharma.

Figures

Fig. 1
Fig. 1
PRISMA flow chart depicting the process of screening and selection of studies for the systematic review.
Fig. 2
Fig. 2
Forest plot showing the pooled seroconversion rate after a single dose of mRNA vaccine in IMIDs.
Fig. 3
Fig. 3
Forest plot showing the pooled seroconversion rate after two doses of mRNA vaccine in IMIDs.
Fig. 4
Fig. 4
Forest plot showing the pooled odds ratio of seroconversion after SARS-CoV-2 vaccination in patients with IMIDs as compared to healthy controls.
Fig. 5
Fig. 5
Forest plots depicting the pooled seroconversion rates after two doses of mRNA vaccine in IMID subtypes.
Fig. 6
Fig. 6
Forest plots depicting the pooled seroconversion rates after two doses of mRNA vaccine after various drug exposures.
Fig. 7
Fig. 7
Forest plot depicting the pooled odds ratio of seroconversion after SARS-CoV-2 vaccination in patients receiving anti-TNF monotherapy as compared to anti-TNF in combination with an immunomodulator.
See this image and copyright information in PMC

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