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. 2022 Jun;81(6):875-880.
doi: 10.1136/annrheumdis-2021-222045. Epub 2022 Feb 23.

Efficacy of COVID-19 vaccines in patients taking immunosuppressants

Chen Shen  1 , Malcolm Risk  1 , Elena Schiopu  2 , Salim S Hayek  3 , Tiankai Xie  1 , Lynn Holevinski  4 , Cem Akin  5 , Gary Freed  6 , Lili Zhao  7
Affiliations

Efficacy of COVID-19 vaccines in patients taking immunosuppressants

Chen Shen et al. Ann Rheum Dis. 2022 Jun.

Abstract

Objectives: We intended to assess the effectiveness of all three US Food and Drug Administration approved COVID-19 vaccines at preventing SARS-CoV-2 infection and COVID-19 hospitalisation in a large cohort of individuals on immunosuppressants for a diverse range of conditions.

Methods: We studied the effectiveness of BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna) and Ad26.COV2.S (Johnson & Johnson-Janssen) vaccines among individuals who take immunosuppressants (including disease-modifying antirheumatic drugs and glucocorticoids) by comparing vaccinated (n=97688) and unvaccinated (n=42094) individuals in the Michigan Medicine healthcare system from 1 January to 7 December 2021, using Cox proportional hazards modelling with time-varying covariates.

Results: Among vaccinated and unvaccinated individuals, taking immunosuppressants increased the risk of SARS-CoV-2 infection (adjusted HR (aHR)=2.17, 95% CI 1.69 to 2.79 for fully vaccinated and aHR=1.40, 95% CI 1.07 to 1.83 for unvaccinated). Among individuals taking immunosuppressants, we found: (1) vaccination reduced the risk of SARS-CoV-2 infection (aHR=0.55, 95% CI 0.39 to 0.78); (2) the BNT162b2 and mRNA-1273 vaccines were highly effective at reducing the risk of SARS-CoV-2 infection (n=2046, aHR=0.59, 95% CI 0.38 to 0.91 for BNT162b2; n=2064, aHR=0.52, 95% CI 0.33 to 0.82 for mRNA-1273); (3) with a smaller sample size (n=173), Ad26.COV2.S vaccine protection did not reach statistical significance (aHR=0.34, 95% CI 0.09 to 1.30, p=0.17); and (4) receiving a booster dose reduced the risk of SARS-CoV-2 infection (aHR=0.42, 95% CI 0.24 to 0.76).

Conclusions: The mRNA-1273 and BNT162b2 vaccines are effective in individuals who take immunosuppressants. However, individuals who are vaccinated but on immunosuppressants are still at higher risk of SARS-CoV-2 infection and COVID-19 hospitalisation than the broader vaccinated population. Booster doses are effective and crucially important for individuals on immunosuppressants.

Keywords: COVID-19; autoimmune diseases; autoimmunity; epidemiology; vaccination.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1.
Figure 1.
Unadjusted cumulative incidence curves of SARS-CoV-2 infection (A) and COVID-19 hospitalization (B) based on calendar time. Unadjusted CI curves of SARS-CoV-2 infection (C) and COVID-19 hospitalization (D) based on vaccination time.
Figure 2.
Figure 2.
Hazard ratios for SARS-CoV-2 infection and COVID-19 hospitalization for each vaccine group compared to the unvaccinated group among immunosuppressed and immunocompetent individuals. Comparisons using multivariable Cox Model adjusting for age, gender, race, and CCI.
Figure 3.
Figure 3.
Unadjusted CI curves of SARS-CoV-2 infection in immunosuppressed individuals who took a booster dose or not based on calendar time.
See this image and copyright information in PMC

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