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. 2022 Jul 1;61(13):1953-1958.
doi: 10.2169/internalmedicine.9223-21. Epub 2022 Apr 23.

Immunogenicity against the BNT162b2 mRNA COVID-19 Vaccine in Rheumatic Disease Patients Receiving Immunosuppressive Therapy

Koichi Sugihara  1 , Risa Wakiya  1 , Hiromi Shimada  1 , Tomohiro Kameda  1 , Shusaku Nakashima  1 , Mikiya Kato  1 , Taichi Miyagi  1 , Mao Mizusaki  1 , Rina Mino  1 , Yumi Nomura  2 , Masayuki Inoo  3 , Norimitsu Kadowaki  1 , Hiroaki Dobashi  1
Affiliations

Immunogenicity against the BNT162b2 mRNA COVID-19 Vaccine in Rheumatic Disease Patients Receiving Immunosuppressive Therapy

Koichi Sugihara et al. Intern Med. .

Abstract

Objective To investigate the serum total antibody (immunoglobulin M and immunoglobulin G) titre against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein receptor-binding domain following BNT162b2 messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccination in Japanese rheumatic disease patients undergoing immunosuppressive therapy. Methods The serum antibody titre against SARS-CoV-2 spike protein was analysed in 123 outpatients with rheumatic diseases at Kagawa University Hospital and 43 healthy volunteers who had received 2 doses of the BNT162b2 mRNA vaccine with at least 14 days elapsing since the second dose. Results The antibody titre in rheumatic disease patients was significantly lower than that in healthy subjects (p<0.0001). The antibody titres of the 41 patients who received biologics or Janus kinase inhibitors and the 47 patients who received conventional immunosuppressive agents were significantly lower than those of the 35 patients who did not receive immunosuppressive agents (p<0.0001 and p<0.0001, respectively). In addition, the mean antibody titre of the 43 patients on methotrexate was significantly lower than that of the 80 patients not on methotrexate (p=0.0017). Conclusion Immunogenicity to the BNT162b2 mRNA COVID-19 vaccine in rheumatic disease patients was found to be reduced under immunosuppressive treatment. In particular, methotrexate seems to be associated with a decreased antibody response.

Keywords: COVID-19; antibody response; immunosuppression; mRNA vaccine; rheumatic disease.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Serum antibody titre against the SARS-CoV-2 spike protein in patients with rheumatic diseases (RMD) and healthy controls. ** indicates a p value less than 0.01.
Figure 2.
Figure 2.
Serum antibody titre against the SARS-CoV-2 spike protein in patients with rheumatic diseases treated with biologics/Janus kinase inhibitors, conventional immunosuppressants, or no immunosuppressants and healthy controls. ** indicates a p value less than 0.01. Bio/JAKi: biologics or Janus kinase inhibitors, Conv-IS: conventional immunosuppressant, w/o IS: without immunosuppressant, control: healthy control
Figure 3.
Figure 3.
Serum antibody titre against the SARS-CoV-2 spike protein in patients with rheumatic diseases treated with or without methotrexate (MTX). ** indicates a p value less than 0.01.
Figure 4.
Figure 4.
Serum antibody titre against the SARS-CoV-2 spike protein in rheumatic disease patients with or without methotrexate and with or without biologics/Janus kinase inhibitors. ** indicates a p value less than 0.01. MTX-/Bio JAKi-: without methotrexate and also without biologics nor Janus kinase inhibitors; MTX-/Bio JAKi+: without methotrexate, but with either biologics or Janus kinase inhibitors; MTX+/Bio JAKi-: with methotrexate but without biologics nor Janus kinase inhibitors; MTX+/Bio JAKi+: with methotrexate and also with either biologics or Janus kinase inhibitors.
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