Patients with IMIDs demonstrate lower, less durable COVID-19 vaccine response
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Patients with immune-mediated inflammatory diseases demonstrate a lower, less durable COVID-19 vaccine response and are at risk for losing humoral immune protection, according to data published in The Lancet Rheumatology.
“This also applies to patients with immune-mediated inflammatory diseases (IMIDs) who are currently not receiving treatment, suggesting that the IMID status per se blunts vaccination responses,” Georg Schett, MD, of Friedrich-Alexander University, in Erlangen, Germany, told Healio. “The situation is further enhanced by drugs that influence adaptive immune responses — T cells or B cells — and also in cases of higher age. Overall, peak responses are lower, and duration of vaccination responses is shorter, in IMID patients than in healthy controls.”
To investigate the effectiveness and longevity of the protection offered by COVID-19 vaccination in patients with IMIDs, Schett and colleagues conducted a prospective cohort study. Patients with IMIDs, and healthy control participants, were recruited from a study conducted by the Deutsche Zentrum fuer Immuntherapie, a treatment center in Germany focusing on patients with chronic inflammatory diseases, autoimmune diseases and cancers. Patients who visited participating clinics, whether receiving treatment or not for IMIDs, were recruited. Healthy hospital employees made up the group of healthy controls.
The researchers used a questionnaire to collect information including demographics and comorbidities. Patients were eligible to be included in the analysis if they had been diagnosed with IMIDs, including rheumatoid arthritis, spondyloarthritides, psoriasis, inflammatory bowel disease, polymyalgia rheumatica and other “miscellaneous” IMIDs, the researchers wrote. Patients were excluded if they had not received a clear diagnosis, if they had organ-specific autoimmunity, malignancy or an uncertain diagnosis.
The analysis included all vaccines approved in Germany at the time the sampling occurred. These included the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) formulations, and the viral vector Ad26.COV2.S (Johnson & Johnson) and ChAdOx1 nCov-19 (Oxford-AstraZeneca) vaccines. All included patients were vaccinated according to approved schedules, including booster doses.
Participants were told to cease immunosuppressive drugs 2 weeks before and after vaccine administration. Methotrexate and T-cell targeting drugs were held for 1 week before and after vaccination, and Janus kinase inhibitors were held for 1 day before and after vaccination. The analysis included serum samples gathered between Dec. 15, 2020, and Dec. 1, 2021. Samples were provided by patients at routine clinical visits. The main outcomes included the optical density ratio values representing antibody titers, and a poor vaccine response as defined by an optical density ratio of less than 1.1.
The analysis included 2,535 patients with IMIDs and 1,198 healthy controls. Overall, the healthy control participants demonstrated a higher average of antibody titers (mean optical density ratio = 12.48; 95% CI, 11.5-13.53), compared with patients with IMIDs (mean optical density ratio = 5.5; 95% CI, 5.23-5.77), according to the researchers. In addition, patients receiving B- and T-cell inhibitors demonstrated poor vaccine responses, with peak mean differences, compared with health controls, of 11.68 (95% CI, 10.07-13.29) and 10.43 (95% CI, 8.330-12.53), respectively.
Patients with IMIDs who received a third vaccine dose demonstrated higher average antibody titers than control participants who received two doses at 40 weeks after initial vaccination (mean difference = 1.34; 95% CI, 0.01-2.69).
“Consider booster vaccination earlier in IMID patients as the longevity of vaccination response is shorter,” Schett said. “Booster vaccination allows responses in IMID patients to catch up with healthy controls. Heterologous immunization — vector/mRNA — is as good as homologous mRNA vaccination in IMID patients with respect to the immune response. Only homologous vector immunization yields lower responses.”
Reference:
Deutsches Zentrum Immuntherapie. https://www.dzi.uk-erlangen.de/en/. Accessed Sept. 16, 2022.
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