mRNA COVID-19 vaccines elicit antibodies in most adults on immunosuppressants

Nearly 90% of adults with chronic inflammatory disease who were taking immunosuppressive medication had an antibody response after receiving an mRNA vaccine for SARS-CoV-2, according to findings in Annals of Internal Medicine.

However, data showed that the response was about one-third as strong as antibody responses in patients who were not taking immunosuppressive medication.

“We observed that patients with [chronic inflammatory disease (CID)] receiving glucocorticoids and [B-cell depletion therapy (BCDT)] developed numerically low or absent [anti-SARS-CoV-2 spike (anti-S)] IgG and neutralizing antibody titers in contrast to other participants with CID,” Parakkal Deepak, MBBS, MS, an assistant professor of medicine at Washington University School of Medicine, and colleagues wrote.

Deepak and colleagues conducted the prospective, observational COVID-19 Vaccine Responses in Patients with Autoimmune Disease (COVaRiPAD) study to determine the immunogenicity of COVID-19 vaccines among adults receiving immunosuppressive medication. The cohort included hospital employees of any age and patients aged older than 65 years who volunteered to receive two doses of the BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna) vaccine between December 10, 2020, and March 20, 2021. Among the study participants, 133 had CID, 53 were immunocompetent, 74.4% were women and 88% were white. Most participants continued their prescribed drug regimens during the study.

The researchers assessed the participants for anti-S IgG binding and neutralizing antibody titers within 2 weeks before their first vaccine dose and 20 days following the final dose. They reported that all immunocompetent participants and 88.7% of those with CID developed antibodies after vaccination. However, immunogenicity was lower in the 10 participants with CID receiving BCDT (60%) and 17 participants with CID receiving glucocorticoids (65%). The geometric mean of anti-S IgG antibodies was 357 (95% CI, 96-1324) among participants receiving prednisone vs. 2,190 (95% CI, 1,598-3,002) among those not on prednisone, according to Deepak and colleagues. Immunogenicity differed between those who were and were not receiving antimetabolites, tumor necrosis factor inhibitors and Janus kinase inhibitors, although confidence intervals were “wide and overlapped,” the researchers wrote.

“Although mRNA-based SARS-CoV-2 vaccination provides protection in immunocompetent persons, immunogenicity in immunosuppressed patients with CID is unclear,” Deepak and colleagues wrote.