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. 2022 Jul;81(7):1017-1022.
doi: 10.1136/annrheumdis-2021-221788. Epub 2022 Mar 18.

Response to SARS-CoV-2 vaccination in systemic autoimmune rheumatic disease depends on immunosuppressive regimen: a matched, prospective cohort study

Peter Mandl #  1 , Selma Tobudic #  2 , Helmut Haslacher  3 , Thomas Karonitsch  4 , Daniel Mrak  4 , Thomas Nothnagl  5 , Thomas Perkmann  3 , Helga Radner  4 , Judith Sautner  5 , Elisabeth Simader  4 , Florian Winkler  4   2 , Heinz Burgmann  2 , Daniel Aletaha  4 , Stefan Winkler #  2 , Stephan Blüml #  4
Affiliations

Response to SARS-CoV-2 vaccination in systemic autoimmune rheumatic disease depends on immunosuppressive regimen: a matched, prospective cohort study

Peter Mandl et al. Ann Rheum Dis. 2022 Jul.

Abstract

Objective: To assess the humoral response to messenger RNA (mRNA) vaccine of patients with systemic autoimmune rheumatic disease (SARD) and the effect of immunosuppressive medication in a matched cohort study.

Methods: Patients with SARD were enrolled and matched 1:1 for sex and age with healthy control (HC) subjects. Differences in humoral response to two doses of an mRNA vaccine in terms of seroconversion rate (SCR) and SARS-CoV-2 antibody level between the two groups and the impact of treatment within patients with SARD were assessed.

Results: We enrolled 82 patients with SARD and 82 matched HC. SCR after the first dose was lower among the patient group than that of HC (65% compared with 100% in HC, p<0.0001) but levelled up after the second dose (94% vs 100%). After the second dose, SCR was lower for patients on combination disease-modifying antirheumatic drug (DMARD) therapy compared with all other groups (81% compared with 95% for monotherapy, p=0.01; 100% for both no DMARD therapy and HC, both p<0.0001). In addition, antibody levels after both doses were lower in patients compared with HC. We found that vaccination response was determined primarily by the number of DMARDs and/or glucocorticoids received, with patients receiving combination therapy (dual and triple therapy) showing the poorest response.

Conclusions: Patients with SARD showed a good response after the second vaccination with an mRNA vaccine. However, the choice of immunosuppressive medication has a marked effect on both SCR and overall antibody level, and the number of different immunomodulatory therapies determines vaccination response.

Keywords: COVID-19; immune system diseases; systemic vasculitis; vaccination.

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Conflict of interest statement

Competing interests: PM reports speaker fees from AbbVie, Janssen and Novartis and research grants from AbbVie, BMS, Novartis, Janssen, MSD and UCB, outside the submitted work. HH received grants from Glock Health, BlueSky Immunotherapies and Neutrolis. JS is the President of the Austrian Society of Rheumatology and Rehabilitation (unpaid position). HB received consulting fees from MSD, Pfizer, Takeda and Gilead, speaker fees from Shionogi, Pfizer and MSD, and advisory boards for Valneva, MSD and Gilead. DA reports grants from AbbVie, Amgen, Lilly, Novartis, Roche, SoBi and Sanofi, and other from AbbVie, Amgen, Lilly, Merck, Novartis, Pfizer, Roche and Sandoz, outside the submitted work. SB reports personal fees from AbbVie and Novartis, outside the submitted work. ES reports support for meeting attendances from Pfizer and Bristol Myers Squibb. HR, TK, DM, TN, TP, FW, SW and ST have nothing to declare.