Author: Tomé, Patrícia ; Barra, Cátia ; Borges, Ana ; Santos, Lèlita ; Magalhães, Ana ; Paiva, Artur ; Crespo, Jorge ; Silva, Isabel ; Teles, Carolina

INTRODUCTION AND OBJECTIVESPatients with systemic autoimmune rheumatic disease (SARD) are a vulnerable population for severe COVID-19 and worse response to vaccination, prompting the need of a booster vaccine. Data regarding its response is limited and inconsistent. The aim of this study was to assess the effectiveness and immunogenicity of the third dose of the SARS-CoV-2 vaccine in immunosuppressed SARD patients.MATERIALS AND METHODSWe conducted a prospective study in immunosuppressed SARD Portuguese patients, who received a SARS-CoV-2 booster vaccine, from October 2021 to August 2022. We evaluated COVID-19 incidence in the following 6 months, as well as vaccine immunogenicity through anti-Spike IgG titers and T-cell reactivity to the Spike protein.RESULTSWe included 131 patients with a mean age of 54.9±12.2 years. Almost 40% (n=52) developed COVID-19 within 6 months after the booster, but 51 (98.1%) were mild infections. Median post-booster antibody levels and antibody variation were 9540.7 (14,724) and 8937.9 (11,561.3)AU/mL, respectively, and 73.3% (n=96) of the patients showed post-booster T-cell reactivity. Antibody variation was significantly lower in the COVID group (p=0.015). Although post-booster antibody levels and T-cell reactivity were statistically significantly lower in the patients under biologic DMARD, there was not a significant increase in COVID-19 incidence.CONCLUSIONSThis study shows that a booster vaccine elicits strong immunogenicity and reduces COVID-19 severity, highlighting its importance in immunosuppressed SARD patients. Larger and more homogeneous cohorts are needed to guide periodic booster administration in this susceptible population.

01 Apr 2025·Archives of Medical Research

Humoral Immune Response to SARS-CoV-2 Vaccines in Patients with Autoimmune Rheumatic Diseases

Article

Author: Tomas-Grau, Rodrigo Hernán ; Pingitore, Esteban Vera ; Soliz-Santander, Silvana Estefanía ; Pera, Mariana ; Socias, Sergio Benjamín ; Leguizamón, María Lilia ; Cazorla, Silvia Inés ; Bertolaccini, María Constanza ; Barbaglia, Ana Lucía ; Ávila, César Luis ; Corbalan, Paula María ; Lucero, Luciana González ; Espasa, Gabriela Vanesa ; Ploper, Diego ; Maldonado-Galdeano, Carolina ; Sueldo, Héctor Raúl ; Bellomio, Verónica Inés ; Chehín, Rosana Nieves

BACKGROUNDPatients with autoimmune rheumatic diseases (ARD) are at increased risk of infection due to their impaired immune response, which also reduces vaccination efficacy. Although several studies have evaluated the serological response to SARS-CoV-2 mRNA-based vaccines in patients with ARD, limited information on immune responses to other vaccination platforms is available.AIMSThis observational prospective study aims to investigate the humoral immune response to different SARS-CoV-2 vaccines in patients with ARD.METHODSTotal 66 patients with ARD who were scheduled to receive any SARS-CoV-2 vaccine (Gam-COVID-Vac; AZD1222; BBIBP-CorV; mRNA-1273; BNT162b2 and Ad5-nCoV) were enrolled in the study. We analyzed the humoral immune response elicited against the spike receptor-binding-domain (RBD) of SARS-CoV-2 at 0 and 14 ± 2 d after the first vaccine dose and at 0 ± 1, 21-45, and 180 d after the second one. Titers were also measured in patients who received an additional dose of vaccine.RESULTSAfter the second dose of the vaccine, 70.5% experienced seroconversion. The type of vaccine affected serological responses. BBIBP-CorV resulted in lower seroconversion rates, while mixed vaccinations increased anti-RBD titers. Other factors impacting seroconversion were higher prednisone doses, biological therapy, and hypertension. Patients treated with Rituximab had the lowest seroconversion rate. Regression analysis revealed an 89.0% lower probability of seroconversion for BBIBP-CorV recipients and an 88.0% lower probability for those with hypertension. An additional dose increased seroconversion to 85.7%.CONCLUSIONSTwo-dose vaccination schemes exhibited a 70.5% seroconversion rate to the SARS-CoV-2 vaccine. An additional dose increased this rate to 85.0%. Reduced humoral immune responses were associated with BBIBP-CorV, prednisone higher doses, and biological therapy.

14 Feb 2025·Science Advances

Humoral responses to SARS-CoV-2 vaccine in vasculitis-related immune suppression

Article

Author: Csiba, Kata ; Kemp, Steven A. ; Kamelian, Kimia ; Gupta, Ravindra K. ; Cheng, Mark Tsz Kin ; Altaf, Mazharul ; Turner, Sam ; Abdullahi, Adam ; Bradley, John ; Smith, Rona M. ; Smith, Kenneth G. C. ; Meng, Bo ; Smith, Derek ; Mlcochova, Petra ; Jones, Rachel B. ; Doffinger, Rainer ; Sievers, Benjamin ; Chen-Xu, Michael ; Collier, Dami A.

Immune suppression poses a challenge to vaccine immunogenicity. We show that serum antibody neutralization against SARS-CoV-2 Omicron descendants was largely absent post-doses 1 and 2 in individuals with vasculitis treated with rituximab. Detectable and increasing neutralizing titers were observed post-doses 3 and 4, except for XBB. Rituximab in vasculitis exacerbates neutralization deficits over standard immunosuppressive therapy, although impairment resolves over time since dosing. We observed discordance between detectable IgG binding and neutralizing activity specifically in the context of rituximab use, with high proportions of individuals showing reasonable IgG titer but no neutralization. ADCC response was more frequently detectable compared to neutralization in the context of rituximab, indicating that a notable proportion of binding antibodies are non-neutralizing. Therefore, use of rituximab is associated with severe impairment in neutralization against Omicron descendants despite repeated vaccinations, with better preservation of non-neutralizing antibody activity.

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