Compared with healthy control participants, patients with psoriatic arthritis (PsA) may have a reduced humoral response after COVID-19 vaccination, according to study results published in Frontiers in Medicine: Dermatology.
The aim of the study was to determine the effect of immunomodulatory therapy in PsA on response to the COVID-19 vaccine.
Adult patients with PsA receiving immunomodulatory therapy, including antitumor necrosis factor α (anti-TNF-α) therapy, secukinumab, or methotrexate, were eligible for inclusion in the study.
The mRNA BNT162b2 SARS-CoV-2 vaccine was administered to all study participants who were then examined at week 3 after the second dose for anti-SARS-CoV-2 spike receptor-binding domain (RBD) IgG antibody value and absolute and percentage lymphocyte subsets. Serum antibody levels among the control group were also assessed.
The Shapiro-Wilk test was used to measure normality of distribution, and frequency distribution was used to describe categoric variables.
A total of 110 patients (65% women; mean age, 61.72±12 years) with PsA in remission, as well as 96 healthy control participants, were included in the study. Of these, 63 received anti-TNF-α therapy (etanercept, adalimumab, certolizumab pegol, and golimumab), 37 received secukinumab, and 10 received methotrexate.
The mean Disease Activity in Psoriatic Arthritis (DAPSA) score was 2.96±0.60, with no significant association between different treatments (P =.779). The median level of neutralizing antibodies to SARS-CoV-2 spike RBD was 928.00 binding antibody units (BAU)/mL (IQR, 329.25-1632.00 BAU/mL). Among the different treatment subgroups, the median values were as follows: methotrexate, 1068.00 BAU/mL (IQR, 475.00-1632.00 BAU/mL); etanercept, 846.00 BAU/mL (IQR, 125.00-1632.00 BAU/mL); anti-interleukin (IL)-17, 908.00 BAU/mL (IQR, 396.00-1632.00 BAU/mL), and TNF-α inhibitors, 1148.00 BAU/mL (IQR, 327.00-1632.00 BAU/mL). Researchers did not observe statistically significant differences between the subgroups (P =.73).
The control group had significantly higher mean serum antibody levels (1562.00 BAU/mL [IQR, 975.00-1632.00 BAU/mL]) than the PsA group (P ≤.001). Lymphocyte subsets did not statistically differ among subgroups or between those with PsA and control participants.
Study limitations included a lack of immune functional tests, a methotrexate dosage that may not be generalizable to others with PsA, a lack of inclusion of other treatments for PsA, and potential confounding from different mean ages between groups.
The study researchers concluded that “systemic therapy for [PsA]…may lead to a reduced quantitative humoral response when compared with healthy [control participants]” and that “global seroconversion rate seems not to be significantly affected.” The researchers added, “Further studies are needed to identify reliable indicators of [cellular response’s] involvement and to clarify whether immunomodulatory treatments may affect it and how.”
Benucci M, Damiani A, Infantino M, et al. Vaccination for SARS-CoV-2 in patients with psoriatic arthritis: can therapy affect the immunological response? Front Med. Published online February 28, 2022. doi:10.3389/fmed.2022.811829