Patients on hemodialysis respond better to Moderna vs. Pfizer vaccines
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Although the COVID-19 antibody and immune responses were delayed in patients on dialysis, their responses were “substantially stronger” to the Moderna vaccine than the Pfizer-BioNTech vaccine.
However, the vaccine type was only one of the various characteristics predicting the strength of patients’ immune responses after vaccination, according to data published in the Journal of the American Society of Nephrology.
“Preliminary evidence suggests patients on hemodialysis have a blunted early serological response to SARS-CoV-2 vaccination. Optimizing the vaccination strategy in this population requires a thorough understanding of predictors and dynamics of humoral and cellular immune responses to different SARS-CoV-2 vaccines,” An S. De Vriese, MD, PhD, professor of medicine and health sciences in the department of internal medicine and pediatrics at Ghent University, and colleagues wrote. “Humoral immune responses to SARS-CoV-2 are mediated by antibodies that are directed to viral surface glycoproteins, mainly the S glycoprotein and the N protein. Although the relationship between antibody titers and effector function is poorly understood, current insight is that neutralizing antibody levels may serve as an immune correlate of protection from infection.”
In a prospective multicenter study, researchers compared the immune response of 543 patients on chronic hemodialysis (62% were men; median age was 75 years; median dialysis vintage was 2.15 years) and 75 healthy volunteers (51% were men; median age was 40 years).
Participants were given two doses of either the Pfizer-BioNTech COVID-19 vaccine 30 µg per dose with a 3-week interval, or the Moderna COVID-19 vaccine 100 g per dose with a 4-week interval.
Researchers used interferon-gamma secretion of peripheral blood lymphocytes upon SARS-CoV-2 glycoprotein stimulation (QuantiFERON assay) to determine anti-SARS-CoV-2 spike antibodies and T-cell response. Researchers also observed possible predictors of the responses. Researchers took blood samples at baseline and at 4 and 8 weeks after the first vaccine dose in Pfizer-BioNTech vaccine recipients, and at 5 and 9 weeks after the first vaccine dose in Moderna vaccine recipients.
The patients on hemodialysis experienced “an incomplete, delayed humoral immune response and a blunted cellular immune response,” compared with the healthy volunteers. Patients vaccinated with the Moderna vaccine showed greater geometric mean antibody titers at both follow-ups than those vaccinated with Pfizer-BioNTech. At 8 or 9 weeks, 53.6% of patients vaccinated with Moderna achieved the threshold of 4160 AU/mL, corresponding with high neutralizing antibody titers in vitro, while only 31.8% of those vaccinated with Pfizer-BioNTech reached the threshold.
“We believe that a high-dose vaccine may be a valid strategy to improve SARS-CoV-2 vaccine effectiveness in hemodialysis patients. The most vulnerable patients—those who are using immunosuppressive drugs, have a low serum albumin, a low lymphocyte count, are hepatitis B vaccine non-responders, or have a high dialysis vintage—may be good candidates for a third vaccine dose,” De Vriese said in a press release.
Similarly, patients vaccinated with Moderna showed a significantly greater median QuantiFERON response at both time points, and a larger proportion achieved the threshold of 0.15 IU/mL (64.4% vs. 46.9% at 8 or 9 weeks). Independent predictors of the humoral and cellular responses at both time points include COVID-19 experience, vaccine type, use of immunosuppressive drugs, serum albumin, lymphocyte count, hepatitis B vaccine non-responder status and dialysis vintage. Age was only an independent predictor at weeks 4 or 5.
“The strikingly different responses in [Pfizer-BioNTech] and [Moderna] recipients suggest that an initial high-dose vaccine may be a valid strategy to improve vaccine effectiveness in vulnerable populations,” De Vriese and colleagues wrote. “Future analysis of the longevity of the immune response to vaccination will allow the determination of the potential additional role of booster doses.”
Reference:
- Study examines immune responses in patients with kidney failure after receiving different COVID-19 vaccines. https://www.newswise.com/arthttps://www.newswise.com/coronavirus/study-examines-immune-responses-in-patients-with-kidney-failure-after-receiving-different-covid-19-vaccines/?article_id=761176&sc=mwhr&xy=10007438icles/blood-metabolites-associated-with-coffee-consumption-may-affect-kidney-disease-risk?sc=cwhr&xy=10007438. Published Nov. 22, 2021. Accessed Dec. 6, 2021.
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