Longer interval between COVID-19 vaccine doses increases antibody levels in IRD patients
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SAN DIEGO — A longer interval between the second and third SARS-CoV-2 vaccine doses results in greater antibody response in patients with inflammatory rheumatic diseases, according to data presented at ACR Convergence 2023.
“We know that extending the period between vaccinations increases the antibody levels against COVID in healthy individuals,” Axel Finckh, MD, leader of clinical research in the division of rheumatology at the University of Geneva, told attendees.
Finckh and colleagues had performed a previous study that suggested patients with inflammatory rheumatic diseases who received the mRNA-1273 COVID-19 (Moderna) vaccine formulation for their primary series had higher humoral immune responses compared with those immunized with BNT162b2 (Pfizer).
To assess whether the interval between second and third doses affects COVID-19 vaccine response, as well as compare the impacts of the mRNA-1273 or the BNT162b2 formulations on anti-SARS-CoV-2 spike IgG levels, in patients with inflammatory rheumatic diseases, the researchers recruited patients from the same Swiss cohort.
The current analysis included 344 patients with inflammatory rheumatic diseases who received a third COVID-19 vaccine dose between Aug. 13, 2012, and March 4, 2022. Participants completed an electronic questionnaire about their vaccine doses and provided blood samples for anti-S1-IgG level testing.
The cohort was 67% women, with a mean age of 52 years. Further baseline data showed that 34% of the study population had rheumatoid arthritis, while 36% had axial spondyloarthritis, 22% had psoriatic arthritis and 8% had undifferentiated arthritis. The mean interval between the second and third doses was 214 days (standard deviation, 25).
According to the researchers, the longer the interval between doses, the higher the antibody response was at 180 days following vaccination. This trend persisted after adjusting for potential confounders such as age and previous SARS-CoV-2 infection.
Specifically, prolonging the interval between second and third doses by 30 days yielded a 1.9-fold increase (95% CI, 1.2-3) in the likelihood of a higher antibody level after the third dose.
In all, 160 patients reported a SARS-CoV-2 infection after their third dose. These infections occurred between Dec. 28, 2021, and Dec. 5, 2022, which the researchers noted was when the B.1.1.529 omicron variant was circulating.
In addition, the researchers did not observe that the vaccination interval impacted the risk for testing positive up to 365 days after the third dose.
“After adjusting for potential confounders, we found that the longer the interval between the second and third vaccination, the higher the antibody levels were,” Finckh said. “This high level of antibodies did not result in less COVID-19 infection.”
Meanwhile, patients who received three doses of the mRNA-1273 vaccine were 3.3 times as likely to have higher anti-S1 levels than those who received the BNT162b2 formulation (P < .001), according to an adjusted analysis.
In addition, compared with the BNT162b2 series, a three-dose series of the mRNA-1273 vaccine reduced the likelihood of a positive SARS-CoV-2 test up to 365 days after the third dose by 36% (HR = 0.64; 95% CI, 0.46-0.89).
“The Moderna vaccine was associated with three to four times higher level of antibodies than the other vaccine in the following year,” Finckh said.
Perspective
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David A. McLain, MD, MACR, FACP, FRCP
As of Dec. 17, 2023, the global count stands at more than 772,000,000 confirmed COVID-19 cases, with nearly 7,000,000 reported deaths. Meanwhile, the economic impact in the United States alone was projected to reach $14 trillion (USD) by the end of 2023, as estimated by a team of economists and experts.
Through the ingenuity of modern science, two mRNA vaccines were developed rapidly that have been shown to prevent and/or lessen the severity of COVID-19. The problem in medicine now is to convince patients to be vaccinated.
As of Nov. 4, 2023, only 14% of Americans have received the updated COVID-19 vaccine, according to the CDC. Additionally, the CDC reports a 37.5% vaccination rate for influenza among American adults, and a 15.9% uptake for RSV vaccines in those aged 60 years and older. Americans, in general, are not receiving recommended vaccines.
Recent research involving about a dozen physicians’ and health organizations, including the American Medical Association, reveals that local doctors are the most trusted source of information for patients, surpassing celebrity doctors and social media influencers. Physicians play a crucial role in countering vaccine misinformation, with 85% of respondents considering their own physician the most trusted source for COVID-19 vaccine information.
So, what are the risks associated with receiving the COVID-19 vaccine? Anaphylaxis has been reported, but at a rate of 5 cases per million. Anaphylaxis can occur with any number of medications and can be treated emergently with — usually — full recovery.
Another source of fear for patients, from my discussions, is the relative or neighbor who received the COVID-19 vaccine and died several days later with a heart attack or stroke. The CDC has investigated this and concluded that vaccinated individuals are less likely to die from COVID-19 and its complications, with no greater risk for death from non-COVID causes compared with those who are unvaccinated. In other words, when millions of people receive a vaccine, coincidental heart attacks and strokes occur just as they do every day in a large population. No cause and effect could be determined relating to the COVID-19 vaccine.
Myocarditis and pericarditis after COVID-19 vaccination are highest among males in their late teens and early 20s, particularly following the second dose. The risk is one in 500,000 — the same risk of being hit by lightning during a 1-year period. Meanwhile, thrombosis with thrombocytopenia syndrome occurred in four in 1,000,000 cases, specifically with the Johnson & Johnson/Janssen COVID-19 vaccine formulation.
The COVID-19 vaccine is safe and effective with a low risk for side effects. We need to continue to encourage our patients to be vaccinated.
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Rubbert-Roth A. Abstract 2567. Presented at: ACR Convergence 2023; Nov. 10-15, 2023; San Diego.
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