Use of TNFi Therapy in Psoriatic Arthritis and COVID-19 Vaccine Immunogenicity: Is There a Link?

Compared with healthy control participants, patients with psoriatic arthritis (PsA) receiving treatment with tumor necrosis factor inhibitors (TNFis) did not show a reduced immune response to the BNT162b2 COVID-19 vaccine, according to study results in RMD Open.

Phase 3 trials of messenger RNA (mRNA) COVID-19 vaccines have historically excluded patients receiving immunosuppressive medications; therefore, the immunogenicity of mRNA vaccines in patients with rheumatic diseases and the association with disease-modifying antirheumatic drug (DMARD) therapy during COVID-19 vaccination has not been clear.

The aim of the current study was to evaluate the immune response to COVID-19 vaccination in patients with PsA receiving TNFi therapy compared with healthy control participants.

Patients with PsA receiving treatment with TNFis received 2 shots of the BNT162b2 mRNA SARS-CoV-2 vaccine (Pfizer-BioNTech) 3 weeks apart. Serum immunoglobulin (Ig) G levels against SARS-CoV-2 were assayed 15 days after the second shot. Treatment with TNFis was continued during the study period. However, among patients receiving combination therapy, methotrexate was discontinued for 1 week after each vaccine dose, according to guidance from the American College of Rheumatology (ACR).

Demographic and clinical characteristics, including disease severity and COVID-19 history/current symptoms, were recorded at baseline and at the time of serum IgG testing. Serum IgG was also measured in the control group 15 days after the second Pfizer-BioNTech COVID-19 vaccine. Differences in immunogenicity between patients and control participants were analyzed using student’s t-test and logistic regression.

A total of 40 patients with PsA (mean age, 52.85±10.41 years; 55% women; mean disease duration, 11±9.0 years) receiving TNFi therapy during COVID-19 vaccination were enrolled in the study.

Researchers noted that PsA disease activity remained consistent before and after vaccination (P =.92). Patients with PsA showed a positive immune response that was lower, but not significantly different, than that of the immune response of the control participants (P =.08).

Methotrexate use among study participants was not associated with lower anti-SARS-CoV-2 IgG levels (P =.07), while glucocorticoid use predicted lower immunogenicity (P =.04).

Limitations of the study included the small sample size and the possibility that patients may have developed asymptomatic SARS-CoV-2 infection before vaccination.

The researchers concluded, “Continuing TNFi therapy in patients with PsA throughout the vaccination period was not associated with hampered immune response and it was safe. Although [methotrexate] was not associated with decreased IgG titers, more data are needed to clarify whether holding [methotrexate] after vaccination may lead to optimal immunogenicity.”

Reference

Venerito V, Stefanizzi P, Fornaro M, et al. Immunogenicity of BNT162b2 mRNA SARS-CoV-2 vaccine in patients with psoriatic arthritis on TNF inhibitors. RMD Open. Published online January 5, 2022. doi:10.1136/rmdopen-2021-001847