Seroconversion After Vaccines Among Patients With RMD

New research appears to confirm that patients with rheumatic and musculoskeletal diseases (RMDs) treated with rituximab and mycophenolate are less likely to mount a robust immune response to vaccines, including vaccines for COVID-19.

Investigators conducted a systematic review and meta-analysis of 25 studies to determine the safety and immunogenicity of SARS-CoV-2 vaccination in patients with RMD. Writing in JCR: Journal of Clinical Rheumatology, the authors extracted information on disease diagnoses, immunosuppressants prescribed, types of vaccine and the proportion of patients who demonstrated serologic response from each study.

“The pooled rate of seroconversion was 0.79 (95% confidence interval [CI], 0.72–0.86). Compared with control subjects, the odds of seroconversion were significantly lower (odds ratio, 0.11; 95% CI, 0.05–0.24),” the authors wrote. “Users of rituximab showed the lowest rate of seroconversion (0.39; 95% CI, 0.29–0.51) followed by mycophenolate (0.56; 95% CI, 0.40–71).”

However, the researchers noted, patients treated with interleukin 17 (0.94; 95% CI, 0.78–0.98) and tumor necrosis factor inhibitors (0.94; 95% CI, 0.84–0.98) evidence high rates of seroconversion when vaccinated for COVID-19. Among patients in the studies, 2% reported severe adverse events and 7% reported diseases flares following the first or second dose.

“Most RD patients developed humoral immune response following vaccination. However, the odds of seroconversion were significantly lower in RD patients compared with controls. This is likely driven by certain immunosuppressants including rituximab and mycophenolate,” the authors wrote. “Future studies need to identify strategies to improve vaccine response in these patients.”

—Rebecca Mashaw

Reference:

Sood A, Tran Minh, Murthy V, Gonzalez E. Immunogenicity and safety of SARS-CoV 2 vaccination in patients with rheumatic diseases: a systematic review and meta-analysis.

J Clin Rheumatol. 2022;28(8):381-389