Covid Vaccination Among Patients with IMID

Patients with immune-mediated inflammatory diseases (IMID) showed reduced response levels and longevity even after 2 doses of SARS-CoV-2 vaccination, a new study indicated. However, the booster dose showed far greater levels of antibodies in patients with IMID, suggesting a need for earlier booster doses or a more frequent booster schedule. The findings of this study are published in the Lancet Rheumatology.

“Because of immune dysfunction and use of immune modulatory drugs in these people, host responses to infection and vaccination are altered and can vary considerably in terms of effectiveness, longevity, and protection against poor outcomes,” the authors explain.

For this large prospective study, the authors selected 2,535 patients with IMID (41.0% males, 58.9% females) and 1198 healthy controls (HC) (53.8% males, 46.2%females), who were either receiving treatment or no treatment between December 2020 and 2021. The mean age for the IMID group was 55.0 years, and for the HC group was 40.7 years.

All patients were administered 2 vaccine doses. Those who showed poor response were given a third/booster dose. The study included patients with spondyloarthritis, rheumatoid arthritis, systemic autoimmune diseases, inflammatory bowel diseases, vasculitis, and psoriasis diagnoses. The study did not include any patients with unclear diagnosis, organ-specific autoimmunity, immunodeficiency, and malignancy.

Upon comparison at any given timepoint after 2 doses, the mean antibody titers were significantly higher in healthy patients (11·50–13·53) vs patients with IMID (5·23–5·77). Patients with IMID taking B-cell inhibitors and T-cell inhibitors exhibited generally poor response to vaccination. When the third dose was given, 40 weeks after initial vaccination, the results were surprising, the investigators stated, as patients with IMID showed a higher count of antibody titers than did the healthy controls (mean difference 1·34; 0·01–2·69).

While people with IMID “show a lower and less durable SARS-CoV-2 vaccination response and are at risk of losing humoral immune protection, adjusted vaccination schedules with earlier booster doses or more frequent re-doses, or both, could better protect people with IMID,” the researchers summarized.

—Priyam Vora

Reference:
Simon D, Tascilar K, Fagni F et al. Intensity and longevity of SARS-CoV-2 vaccination response in patients with immune-mediated inflammatory disease: A prospective cohort study. Lancet Rheumatol. 2022: 4(9);615-625. DOI: https://doi.org/10.1016/S2665-9913(22)00191-6