Patients with rheumatic diseases (RD) mount a “significantly lower” immune response to mRNA vaccines against the SARS-CoV-2 virus, possibly attributable to certain therapeutic agents used to treat their conditions, according to an abstract presented at the American College of Rheumatology Convergence 2021 on November 6.

Akhil Sood, MD, from the University of Texas Medical Branch, Galveston, presented the findings of this systematic review and meta-analysis.

Dr Sood noted that the vaccine has demonstrated efficacy in trials, which largely excluded patients being treated with immunosuppressive therapies. Using recent research that explored the immunogenicity of these vaccines in immunocompromised patients, Dr Sood and colleagues conducted a systematic review and meta-analysis on the humoral immune response among patients with RD to these vaccines.

“We systematically searched PubMed/Medline, Scopus, and MedRxiv from January 1, 2021, through May 30, 2021, to identify eligible studies that examined the immunogenicity of SARS-CoV-2 vaccination in RD patients,” the authors of the abstract wrote, which included “studies that provided data on proportion of RD patients who developed an immune response following the second dose of the vaccine. Immune response was defined as development of IgG antibodies to SARS-CoV-2 S anti-receptor binding domain (RBD) or neutralizing antibodies with cutoffs established by manufacturer.” The investigators also extracted information from each study on type of RD and immunosuppressant use.

The meta-analysis included 3 observational studies and 5 case-control studies comprising 1482 patients with RD. “The pooled response rate following vaccination against SARS-CoV-2 was 0.88 (95% CI 0.75-0.94). Compared to non-RD patients, RD patients had significantly decreased response to SARS-CoV-2 vaccination (RR 0.88, 95% 0.84-0.93),” the authors wrote. “Patients on rituximab (37%), mycophenolate (70.8%), prednisone (86.6%), and methotrexate (91.9%) showed lower vaccine response. On the other hand, patients on TNF (100%), JAK (96.3%), and IL-17 inhibitors (92.9%) showed higher vaccine response.”

The investigators concluded that the attenuated immune response “is likely driven by certain immunosuppressants, particularly B-cell depleting therapy which can hamper the humoral immune response. Future studies need to examine the use and timing of these immunosuppressants prior to SARS-CoV-2 vaccination.”

—Rebecca Mashaw

Reference:
Sood A, Murthy V, Gonzalez E. Efficacy of SARS-CoV-2 vaccine in patients with rheumatic diseases: a systematic review and meta-analysis. Presented at: American College of Rheumatology Convergence 2021; November 5-9, 2021; virtual. Abstract 0108.