Patients with IMIDs respond well to third COVID-19 vaccine dose
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Most patients with immune-mediated inflammatory diseases who had weakened responses to a standard vaccine series for COVID-19 mounted a serological response to a third dose, according to data published in Arthritis and Rheumatology.
“The utility of a third vaccine dose in immunocompromised patients, as well as in the general population, is an urgent question in the global medical community and for policy makers,” Silje W. Syversen, MD, PhD, of Diakonhjemmet Hospital, in Oslo, Norway, and co-authors wrote.
“Findings of a recent study suggested that immunocompromised recipients of a solid organ transplant benefited from a third vaccine dose,” they added. “Apart from a study of a third dose of vaccine in rituximab-treated RA patients, only a case report and small studies (involving 33 or 17 participants) have been published regarding the immunogenicity and safety of a third dose in IMID patients who were receiving other therapies and had no response to the 2-dose vaccination regimen.”
To analyze vaccine response following the standard two-dose regimen and a third dose in patients with immune-mediated inflammatory diseases (IMIDs) using immunosuppressive therapies, Syversen and colleagues conducted Nor-vaC, an ongoing observational study. Adults with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, ulcerative colitis or Crohn's disease were recruited upon receipt of a COVID-19 vaccine, with those deemed eligible invited to participate before the roll out of Norway’s national vaccination program in February 2021. Volunteer health care workers made up the control group.
Patients who mounted weak responses to the standard two-dose course after 4 weeks of follow-up were recruited into a separate intervention study and received a third dose between July 2021 and August 2021.
The main endpoints of the investigation were the proportion of patients who mounted an appropriate serological response, and the anti-RBD levels following a standard course as well as a third dose of vaccination. Another key endpoint was the change in anti-RBD levels following a third vaccine dose. Additional endpoints were adverse events and serological response predictors.
A total of 2,178 patients were included in the study between Feb. 2, 2021, and June 11, 2021, with 1,647 deemed eligible. The group included 566 patients with RA, 305 patients with SpA, 295 patients with PsA, 280 patients with Crohn's disease and 195 patients with ulcerative colitis.
In all, 1,505 (91%) patients in the test group and 1,096 (98%) participants in the control group demonstrated a seriological response to the standard vaccine course. Patients in the test group showed lower anti-RBD levels than the control group, with a median 619 AU per mL vs. median 3,355 AU per mL (P < .001). Patients receiving TNF inhibitor combination therapy, JAK inhibitors and abatacept (Orencia, Bristol Myers Squibb) demonstrated the lowest levels of response, according to the researchers.
Meanwhile, a total of 153 patients responded weakly to the original vaccine series and received a third dose. Of those, 129 (84%) responded to that dose, according to the researchers.
“The present data show a clear benefit in terms of serological response, while the frequency and profile of reported adverse events were comparable to that observed after standard two-dose vaccination,” Syversen and colleagues wrote. “We could not find any benefit on vaccine immunogenicity of pausing medication.
“The humoral response to the third dose was comparable in arthritis patients who were recommended to pause mediation and [inflammatory bowel disease (IBD)] patients who did not receive this recommendation,” they added. “Further, self-reported pausing of medication was not associated with humoral response to standard vaccination. These results must be interpreted with caution, however.”
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