Patients with IMIDs, hybrid immunity may be able to delay fourth COVID-19 vaccine dose
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Patients with immune-mediated inflammatory disease undergoing immunosuppressive therapy gain a “significant immunological boost” following SARS-CoV-2 infection, according to data published in The Lancet Rheumatology.
The researchers added that patients in this population who are infected after receiving three COVID-19 vaccine doses might be better protected than those with a fourth dose. As such, additional doses might be delayed in those with hybrid immunity, they wrote.
That said, the researchers additionally concluded that a fourth COVID-19 vaccine dose is safe and demonstrates “clear benefit” regarding humoral immunity in patients with IMID who are receiving immunosuppressive therapy.
“Several countries now recommend three primary vaccine doses followed by a fourth booster dose for this patient group,” Kristin H. Bjørlykke, MD, of Akershus University Hospital, in Lorenskog, Norway, and colleagues wrote. “Current research interest is focused on the effect of hybrid immunity with SARS-CoV-2 vaccination in combination with COVID-19.
“There is a need to explore the humoral antibody response following hybrid immunization in patients with immune-mediated inflammatory diseases on immunosuppressive therapy,” they added.
To examine hybrid immunity and humoral immune response, as well as safety, following a fourth COVID-19 vaccine dose in patients with IMIDs who are undergoing immunosuppressive therapy, Bjorlykke and colleagues conducted an observational study. The analysis included adults aged 18 years or older with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, Crohn's disease or ulcerative colitis who were receiving immunosuppressive therapy.
Patients were additionally required to express intention to receive COVID-19 vaccinations. Those who exhibited any vaccine allergies or intolerance were excluded.
Patients were consecutively recruited before the rollout of the vaccine program in Norway, in February 2021. Meanwhile, health care workers were recruited as control patients. All patients included in the analysis received the primary vaccination course for patients with IMIDs, consisting of three vaccine doses and a booster, for a total of four doses. The vaccines available initially included the Pfizer-BioNTech, Moderna and AstraZeneca formulations. However, the AstraZeneca vaccine was removed in March 2021.
The analysis included serum results from patients who were tested 2 to 4 weeks after their third and fourth vaccine doses, as well as those who underwent testing 2 to 4 weeks after SARS-CoV-2 infection and healthy controls 2 to 4 weeks following vaccination. Patients who received vaccines and those who were infected after vaccination were both included. The primary outcome was the anti-RBD antibody concentrations 2 to 4 weeks after receiving the vaccine or COVID-19 infection in the analysis groups, or vaccination in the control group.
The analysis included a total of 536 patients who submitted samples following a fourth vaccine dose and 167 patients who reported COVID-19 infection following three vaccine doses. According to the researchers, those receiving vaccinations demonstrated higher levels of anti-RBD antibodies following their fourth dose compared to the third dose (P < .0001). In addition, these patients had lower concentrations than control patients who received three doses (P < .0001). Meanwhile, concentrations were higher in patients who were vaccinated and then were infected with SARS-CoV-2, compared with those who simply had four doses without developing COVID-19 (P < .0001).
“We show a clear benefit regarding humoral immunity of a fourth dose with reassuring safety signals,” Bjørlykke and colleagues wrote. “This study adds to the current debate on how immunization and omicron infection should be considered in an optimal regime for booster vaccinations in this vulnerable population.
“Although we cannot recommend that patients deliberately contract COVID-19, it seems clear that the people with immune-mediated inflammatory diseases obtain a significant immunological boost if they do get infected with SARS-CoV-2, even the omicron variant,” they added. “Hence, immunization in patients with immune-mediated inflammatory diseases who have had COVID-19 after three vaccine doses might be considered superior to a fourth vaccine dose, implying that additional vaccine doses might be postponed in patients with hybrid immunity.”
References:
Shenoy P, et al. Lancet Rheumatol. 2022;doi:10.1016/S2665-9913(21)00356-8.
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