COVID-19 vaccine response varies widely among immunocompromised patients
Click Here to Manage Email Alerts
Approximately 84% of patients with autoimmune diseases develop antibodies from the COVID-19 vaccine, compared with 98.1% of healthy health care workers, according to an interim analysis published in MedRxiv.
The overall findings demonstrate a wide heterogeneity regarding COVID-19 vaccine response in immunocompromised patients, with only one in five participants with a lung transplant developing an antibody response, and a nearly complete response in those with well-controlled HIV, the researchers wrote.
“Not surprisingly, recent studies in transplant, oncology and rheumatology patients have demonstrated that COVID-19 vaccines elicit demonstrable antibody responses well below the 100% response rates seen in healthy volunteers in the reported phase 1/2 trials,” Ghady Haidar, MD, of the University of Pittsburgh School of Medicine, and colleagues wrote. “Despite these emerging data, several unknowns persist, including the degree of the antibody response in seropositive immunocompromised patients, and whether antibodies from immunocompromised patients are capable of neutralizing SARS-CoV-2.”
To analyze antibody responses, levels and neutralization capacity in patients who are immunocompromised after receiving the COVID-19 vaccine, Haidar and colleagues in April 2021 initiated the COVID-19 Vaccination in the Immunocompromised Study (CoVICS). This ongoing observational, prospective cohort study includes 107 healthy health care workers from the University of Pittsburgh Medical Center and 489 immunocompromised adults who completed their COVID-19 vaccination series. Individuals with a history of COVID-19 were excluded.
Researchers collected serum from each participant to measure for the presence of IgG against the SARS-CoV-2 spike protein, based on semi-quantitative assay. In addition, a quasi-random subset of participants was selected for pseudovirus neutralization assays. To identify risk factors for seronegativity, Haidar and colleagues univariately compared clinical characteristics between antibody reactive and non-reactive patients within the immunocompromised group.
According to the researchers, seropositivity was significantly lower (P < .001) in several, but not all, immunocompromised groups compared with the health care workers. Seropositivity rates were 37.2% for patients with solid organ transplant, 83.8% for those with autoimmune disease, 54.7% for those with hematological malignancies and 82.4% with those with solid tumors (P < .05). However, 94.6% of patients with HIV were seropositive.
Among seropositive patients, antibody levels were much lower in those with solid organ transplant (4.5; 95% CI, 2.1-13.1). In addition, neutralization titers closely correlated with antibody levels (Spearman r = 0.91, P < .0001).
“Our study highlights the urgent need to optimize and individualize COVID-19 prevention in patients with immunocompromising conditions and have other treatments — such as monoclonal antibodies — available should vaccination fail,” Haidar said in a press release from the University of Pittsburgh Medical Center. “Given the Centers for Disease Control and Prevention’s recommendations permitting vaccinated people to abandon masking and social distancing in most settings, our findings also have implications for public health guidance, since nearly 4% of Americans are immunocompromised.”
“At this point, clinical advice does not change for immunocompromised people, whether an antibody test is positive or negative,” he added in the release. “They should still wear a mask in public, practice social distancing, get vaccinated and encourage those around them to be vaccinated. A positive antibody test does not give us certainty that they are protected against the virus, and the risk of COVID-19 causing serious complications and death still exists.”
Perspective
Back to Top
Working as an Advanced Practice Provider in rheumatology places me in a position not only to diagnose, treat and manage rheumatic diseases, but also to provide health promotion and help keep my patients healthy by preventing infections. For the past year and a half, COVID-19 has been one the biggest topics in conversation during follow-up visits.
There are hundreds of autoimmune diseases, and some patients suffer from more than one along with multiple comorbidities. This creates even more of an immunocompromised state for patients when choosing treatments and recommending vaccinations. Trying to protect immunocompromised patients from contracting COVID-19 is challenging. Depending on the health and wellness of the patients suffering with rheumatic disease, vaccinations may not fully protect certain patients.
Therefore, it is imperative to educate patients on other ways to stay safe and healthy during this pandemic like wearing a mask, washing hands, refraining from large social gatherings, eating healthy and tobacco cessation just to name a few. Hopefully in time, we will have a better understanding of COVID-19 and immunogenicity of the vaccines to protect patients suffering with rheumatic diseases and other chronic conditions.
Perspective
Back to Top
David A. McLain, MD, MACR, FACP, FRCP
This study and others like it that examine the response to the COVID-19 vaccine by immunocompromised patients are very necessary and helpful. In this study, 84% of patients with autoimmune conditions had positive spike protein antibodies compared with 98% for healthy health care workers. Observations reported by Braun-Moscovici and colleagues in Annals of the Rheumatic Diseases have found that among our immunosuppressed patients, those receiving rituximab, abatacept and mycophenolate mofetil have had impaired antibody production to the COVID-19 spike protein after vaccination.
I have informed patients, particularly those on rituximab, abatacept and mycophenolate mofetil, that they likely may have an impaired antibody response after receiving the vaccine. In one trial 39% of rituximab patients had antibodies, often in patients where the B cell population was recovering; those without CD19+ B cells did not make antibodies. A small study by Bonelli and colleagues in Annals of the Rheumatic Diseases did show that inducible SARS-CoV-2-specific T cells did appear in 58% of those who were vaccinated.
A hematologist-oncologist in my area has the forms and orders ready to go for his immunosuppressed patients to receive casirivimab/imdevimab (Regeneron) or sotrovimab (GlaxoSmithKline) at the first sign of a possible COVID-19 infection. We should be doing the same and informing our patients, particularly those on rituximab, abatacept and mycophenolate mofetil that they should contact us at the first sign of a possible COVID-19 infection or if they test positive. We should be proactive in providing casirivimab/imdevimab or sotrovimab to our patients with early COVID-19.
Collapse
Click Here to Manage Email Alerts