Immunogenicity, breakthrough infection, and underlying disease flare after SARS-CoV-2 vaccination among individuals with systemic autoimmune rheumatic diseases

Abstract

Many patients with systemic autoimmune rheumatic diseases (SARDs) require immunosuppression to reduce disease activity, but this also has important possible detrimental impacts on immune responses following vaccination. The phase III clinical trials for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines did not include those who are immunosuppressed. Fortunately, we now have a clearer idea of how immune responses following SARS-CoV-2 vaccination has for the immunosuppressed, with much of the data being within a year of its introduction. Here, we summarize what is known in this rapidly evolving field about the impact immunosuppression has on humoral immunogenicity including waning immunity and additional doses, breakthrough infection rates and severity, disease flare rates, along with additional considerations and remaining unanswered questions.

Figure 1

Key immunosuppressants associated with reducing antibody response after SARS-CoV-2 vaccination. Those with the strongest evidence are highlighted in the left panel (purple), while those that may reduce antibody response are in the middle panel (green), and those that do not reduce antibody response are in the right panel (orange).