Reduced Humoral Response to COVID-19 Vaccine Among Patients With PsA Receiving Immunomodulatory Therapy

doctor administering vaccine to patient
Doctor gives corona virus vaccine, home care service concept
The aim of the study was to determine the effect of psoriatic arthritis therapy on COVID-19 vaccination response.

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