Strong response after fourth dose of mRNA COVID-19 vaccine in autoimmune rheumatic diseases patients with poor response to inactivated vaccine.

Aikawa, NE ; Kupa, LVK ; et al.

In: Rheumatology (Oxford, England), Jg. 62 (2022-12-23), Heft 1, S. 480-485

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Objectives: To assess immunogenicity of a heterologous fourth dose of an mRNA (BNT162b2) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in autoimmune rheumatic diseases (ARD) patients with poor/non-response to inactivated vaccine (Sinovac-CoronaVac).

Methods: A total of 164 ARD patients who were coronavirus disease 2019 (COVID-19) poor/non-responders (negative anti-SARS-CoV-2 S1/S2 IgG and/or neutralizing antibodies-NAb) to the third dose of Sinovac-CoronaVac received an additional heterologous dose of mRNA (BNT162b2) 3 months after last dose. IgG and NAb were evaluated before and after the fourth dose.

Results: Significant increases were observed after the fourth dose in IgG (66.4 vs 95.1%, P < 0.001), NAb positivity (5.5 vs 83.5%, P < 0.001) and geometric mean titre (29.5 vs 215.8 AU/ml, P < 0.001), and 28 (17.1%) remained poor/non-responders. Patients with negative IgG after a fourth dose were more frequently under rituximab (P = 0.001). Negative NAb was associated with older age (P = 0.015), RA (P = 0.002), SSc (P = 0.026), LEF (P = 0.016) and rituximab use (P = 0.007). In multiple logistic regression analysis, prednisone dose ≥7.5 mg/day (OR = 0.34; P = 0.047), LEF (OR = 0.32, P = 0.036) and rituximab use (OR = 0.19, P = 0.022) were independently associated with negative NAb after the fourth vaccine dose.

Conclusions: This is the largest study to provide evidence of a remarkable humoral response after the fourth dose of heterologous mRNA SARS-CoV-2 vaccination in ARD patients with poor/non-response to the third dose of an inactivated vaccine. We further identified that treatment, particularly rituximab and prednisone, impaired antibody response to this additional dose.

Trial Registration: ClinicalTrials.gov, https://clinicaltrials.gov, CoronavRheum #NCT04754698.

Titel:	Strong response after fourth dose of mRNA COVID-19 vaccine in autoimmune rheumatic diseases patients with poor response to inactivated vaccine.
Autor/in / Beteiligte Person:	Aikawa, NE ; Kupa, LVK ; Silva, CA ; Saad, CGS ; Pasoto, SG ; Yuki, EFN ; Fusco, SRG ; Shinjo, SK ; Andrade, DCO ; Sampaio-Barros, PD ; Pereira, RMR ; Chasin, ACS ; Shimabuco, AY ; Luppino-Assad, AP ; Leon, EP ; Lopes, MH ; Antonangelo, L ; Medeiros-Ribeiro, AC ; Bonfa, E
Link:	Full Text Finder (Volltext)
Zeitschrift:	Rheumatology (Oxford, England), Jg. 62 (2022-12-23), Heft 1, S. 480-485
Veröffentlichung:	Oxford, UK : Avenel, N.J. : Oxford University Press ; Distributed by Mercury International, c1999-, 2022
Medientyp:	academicJournal
ISSN:	1462-0332 (electronic)
DOI:	10.1093/rheumatology/keac301
Schlagwort:	Humans COVID-19 Vaccines BNT162 Vaccine Prednisone Rituximab SARS-CoV-2 Antibodies, Viral Immunoglobulin G RNA, Messenger Vaccines, Inactivated COVID-19 prevention & control Rheumatic Diseases drug therapy
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Research Support, Non-U.S. Gov't Language: English [Rheumatology (Oxford)] 2022 Dec 23; Vol. 62 (1), pp. 480-485. MeSH Terms: COVID-19* / prevention & control ; Rheumatic Diseases* / drug therapy ; Humans ; COVID-19 Vaccines ; BNT162 Vaccine ; Prednisone ; Rituximab ; SARS-CoV-2 ; Antibodies, Viral ; Immunoglobulin G ; RNA, Messenger ; Vaccines, Inactivated Contributed Indexing: Keywords: COVID-19; autoimmune diseases; therapy; vaccination Molecular Sequence: ClinicalTrials.gov NCT04754698 Substance Nomenclature: 0 (sinovac COVID-19 vaccine) ; 0 (COVID-19 Vaccines) ; 0 (BNT162 Vaccine) ; VB0R961HZT (Prednisone) ; 4F4X42SYQ6 (Rituximab) ; 0 (Antibodies, Viral) ; 0 (Immunoglobulin G) ; 0 (RNA, Messenger) ; 0 (Vaccines, Inactivated) Entry Date(s): Date Created: 20220531 Date Completed: 20221227 Latest Revision: 20230223 Update Code: 20231215 PubMed Central ID: PMC9213862

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