Weakened Antibody Response to COVID-19 Vaccine Among Patients Receiving Immunosuppressive Medications

Patients with chronic inflammatory diseases (CIDs) receiving treatment with immunosuppressive medications have impaired SARS-CoV-2 vaccine-induced immunity, with glucocorticoids and B-cell depletion therapy severely inhibiting optimal responses, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

The researchers sought to determine the effectiveness of SARS-CoV-2 vaccines in patients with CIDs for the risk-stratification of those with impaired protection and to provide clinical guidance on medication management.

In the prospective COVID-19 Vaccine Responses in Patients With Autoimmune Disease (COVARIPAD) study, researchers collected blood samples from 197 adults with CIDs and 53 healthy control participants prior to their initial vaccine dose and then 1 to 2 weeks following their second dose. Serum anti-SARS-CoV-2 spike (S) immunoglobulin (Ig)G+ binding and neutralizing antibody titers were quantified to evaluate both the magnitude and the quality of humoral responses after vaccination.

Patients with CIDs had a range of immunologic diagnoses, including inflammatory bowel disease, rheumatoid arthritis, spondyloarthritis, uveitis, systemic lupus erythematosus, connective tissues diseases, Sjögren syndrome, vasculitis, autoinflammatory syndrome, psoriasis, antiphospholipid syndrome, and multiple sclerosis.

In patients with CIDs compared with control participants, a 3-fold decrease in anti-S IgG titers (P =.0046) and SARS-CoV-2 neutralization (P <.0001) to the D614G common variant were reported. The strongest effects were reported with

B-cell depletion and glucocorticoids, with 36-fold and 13-fold reductions, respectively, in humoral responses (P <.0001).

According to multivariate regression analyses, Janus kinase (JAK) inhibitors and antimetabolites, including methotrexate, were also associated with blunted antibody titers (P <.0001 and P =.0023, respectively). The use of other targeted therapies, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-12/23 inhibitors, and integrin inhibitors, had only modest effects on antibody formation and neutralization. 

The researchers concluded that based on the findings from the COVARIPAD study, they are “currently determining cross-variant neutralization, long-term antibody and neutralization titers, and T cell responses in this cohort.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Paley M, Deepak P, Kim W, et al. Immunosuppression attenuates antibody and neutralization titers in patients with chronic inflammatory disease following SARS-CoV-2 vaccination. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 0457.