Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 26;7(2):rkad065.
doi: 10.1093/rap/rkad065. eCollection 2023.

TNF inhibitors significantly attenuate the humoral immune response to COVID-19 vaccination in patients with rheumatoid arthritis

Arne Schäfer  1   2 , Magdolna S Kovacs  3 , Anna Eder  3 , Axel Nigg  3 , Martin Feuchtenberger  2   3
Affiliations

TNF inhibitors significantly attenuate the humoral immune response to COVID-19 vaccination in patients with rheumatoid arthritis

Arne Schäfer et al. Rheumatol Adv Pract. .

Abstract

Objective: Several studies on the immunogenicity of vaccination against coronavirus disease 2019 (COVID-19) in patients with immune-mediated inflammatory diseases have evaluated the influence of DMARDs. The aim of the work presented here was to compare the humoral vaccine response after two vaccinations between patients with RA undergoing TNF inhibitor therapy and healthy controls.

Methods: We assessed the humoral immune response, as measured by titres of neutralizing antibodies against the S1 antigen of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients with RA and anti-TNF treatment vs. controls without immunomodulatory medication. One hundred and seven fully vaccinated individuals were included at 6 ± 1 weeks after the second vaccination [BioNTech/Pfizer (72.9%), AstraZeneca (17.8%) and Moderna (9.3%)]. Immune responses in terms of antibody titres were compared between both subgroups with (n = 45) and without (n = 62) exposure to anti-TNF medication. The comparison was performed as a cross-sectional, single-centre study approach using non-parametric tests for central tendency.

Results: Anti-TNF medication produced a significantly impaired humoral immune response to vaccination against COVID-19. The maximum immune response was detected in 77.4% of control patients, whereas this decreased to 62.2% in participants treated with TNF inhibitors (P = 0.045; effect size, d = 0.194). Patients on combination treatment (anti-TNF medication and MTX, 17 of 45 subjects in the treatment group) did not differ significantly regarding humoral immune response compared with patients on monotherapy with TNF inhibitors only (P = 0.214).

Conclusion: TNF inhibitors significantly reduce the humoral response following dual vaccination against COVID-19 in patients with RA.

Keywords: COVID-19; DMARD; SARS-CoV-2; TNF inhibitor; arthritis; humoral; immunogenicity; rheumatoid; vaccination.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Titres of neutralizing IgG antibodies. Titres of neutralizing IgG antibodies against the S1 antigen of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depending on the use of TNF inhibitors (four-point Likert scale): non-response, <34 BAU/ml; low response, 34–175 BAU/ml; moderate response, 176–383 BAU/ml; and maximum response, ≥384 BAU/ml. Titres of neutralizing antibodies differed significantly between patients receiving TNF inhibitors (n = 45; 62.2% with maximum response) and control patients (n = 62; 77.4% with maximum response; *P = 0.045; d = 0.194). BAU: binding antibody units
See this image and copyright information in PMC

References

    1. Sattui SE, Liew JW, Kennedy K et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open 2021;7:e001814. - PMC - PubMed
    1. Jena A, Mishra S, Deepak P et al. Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: systematic review and meta-analysis. Autoimmun Rev 2022;21:102927. - PMC - PubMed
    1. Christensen IE, Jyssum I, Tveter AT et al. The persistence of anti-Spike antibodies following two SARS-CoV-2 vaccine doses in patients on immunosuppressive therapy compared to healthy controls—a prospective cohort study. BMC Med 2022;20:378. - PMC - PubMed
    1. Hoff LS, Ravichandran N, Shinjo SK et al.; COVAD Study Group. COVID-19 severity and vaccine breakthrough infections in idiopathic inflammatory myopathies, other systemic autoimmune and inflammatory diseases, and healthy controls: a multicenter cross-sectional study from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) survey. Rheumatol Int 2023;43:47–58. - PMC - PubMed
    1. Mauro D, Ciancio A, Di Vico C et al. Serological response to BNT162b2 anti-SARS-CoV-2 vaccination in patients with inflammatory rheumatic diseases: results from the RHEUVAX cohort. Front Immunol 2022;13:901055. - PMC - PubMed

LinkOut - more resources