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Thomas Κ, Grigoropoulos I, Alexopoulou P, Karofylakis E, Galani I, Papadopoulou KK, Tsiavou A, Ntourou A, Mavrou E, Qevani I, Katsimbri P, Koutsianas C, Mavrea E, Vassilopoulos D, Pournaras S, Tsiodras S, Boumpas D, Antoniadou A. Sustained cell-mediated but not humoral responses in rituximab-treated rheumatic patients after vaccination against SARS-CoV-2. Rheumatology (Oxford) 2024; 63:534-541. [PMID: 37228039 PMCID: PMC10836975 DOI: 10.1093/rheumatology/kead236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES B-cell depleting monoclonal antibodies are associated with increased COVID-19 severity and impaired immune response to vaccination. We aimed to assess the humoral and cell mediated (CMI) immune response after SARS-CoV-2 vaccination in rituximab (RTX)-treated rheumatic patients. METHODS Serum and whole blood samples were collected from RTX-treated rheumatic patients 3-6 months after last vaccination against SARS-CoV-2. Serum was tested by ELISA for quantitative detection of anti-spike SARS-CoV-2 IgG. Cell-mediated variant-specific SARS-CoV-2 immunity (CMI) was assessed by interferon-γ release assay Covi-FERON FIA. Patients were interviewed for breakthrough COVID-19 infection (BTI) 3 months post sampling. RESULTS Sixty patients were studied after a median (IQR) of 179 (117-221.5) days from last vaccine to sampling. Forty (66.7%) patients had positive Covi-FERON and 23 (38.3%) had detectable anti-spike IgG. Covi-FERON positive patients had lower median RTX cumulative dose [6 (4-10.75) vs 11 (6.75-14.75) grams, (P = 0.019)]. Patients with positive anti-spike IgG had received fewer RTX cycles [2 (2-4) vs 6 (4-8), P = 0.002] and cumulative dose [4 (3-7) vs 10 (6.25-13) grams, P = 0.002] and had shorter time from last vaccination to sampling [140 (76-199) vs 192 (128-230) days, P = 0.047]. Thirty-seven percent were positive only for Covi-FERON and 7% only for anti-spike IgG. Twenty (33.3%) BTI occurred post sampling, exclusively during Omicron variant predominance. The proportion of patients with CMI response against Delta variant was lower in patients who experienced BTI (25% vs 55%, P = 0.03). CONCLUSIONS Four out of ten RTX-treated vaccinated patients show lasting cell-mediated immune response despite undetectable anti-spike antibodies. Cumulative RTX dose affects both humoral and cell-mediated responses to SARS-CoV-2 vaccines. Cell-mediated immune responses call for attention as a vaccine efficacy marker against SARS-CoV-2.
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Affiliation(s)
- Κonstantinos Thomas
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Ioannis Grigoropoulos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Panagiota Alexopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Emmanouil Karofylakis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Irene Galani
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Kyriaki Korina Papadopoulou
- Clinical Microbiology Laboratory, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Anastasia Tsiavou
- Clinical Microbiology Laboratory, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Aliki Ntourou
- Clinical Immunology-Rheumatology Unit, 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Eleftheria Mavrou
- Clinical Immunology-Rheumatology Unit, 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Irina Qevani
- Clinical Immunology-Rheumatology Unit, 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Pelagia Katsimbri
- Clinical Immunology-Rheumatology Unit, 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Christos Koutsianas
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Evgenia Mavrea
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Vassilopoulos
- Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Dimitrios Boumpas
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
- Clinical Immunology-Rheumatology Unit, 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
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Pappa M, Panagiotopoulos A, Thomas K, Fanouriakis A. Systemic Lupus Erythematosus and COVID-19. Curr Rheumatol Rep 2023; 25:192-203. [PMID: 37477841 PMCID: PMC10504107 DOI: 10.1007/s11926-023-01110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE OF REVIEW To describe the current state of knowledge regarding COVID-19 in patients with systemic lupus erythematosus (SLE). We focus on (i) SARS-CoV-2 vaccination uptake, immunogenicity and safety, and (ii) outcomes of COVID-19 in patients with SLE and pertinent risk factors for adverse sequelae. RECENT FINDINGS Notwithstanding the potential concern of patients about possible post-vaccination side-effects, the safety of anti-SARS-CoV-2 vaccines in patients with SLE has been undisputedly confirmed in numerous studies. Humoral immunogenicity is generally attained in SLE, although affected by the use of background immunosuppressive drugs, especially rituximab. The latter has also clearly been implicated with adverse COVID-19 outcomes in SLE, including need for hospitalization, mechanical ventilation and death. Although the wide adoption of vaccination has significantly improved COVID-19 outcomes, patients with SLE continue to pose challenges during the pandemic, mainly owing to administered immunosuppressive medications.
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Affiliation(s)
- Maria Pappa
- 1st Department of Propaedeutic Internal Medicine, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Panagiotopoulos
- 1st Department of Propaedeutic Internal Medicine, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Thomas
- 4th Department of Internal Medicine, "Attikon" University Hospital, Medical School National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology, "Attikon" University Hospital of Athens, Medical School National and Kapodistrian University of Athens, Athens, Greece.
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Widhani A, Hasibuan AS, Rismawati R, Maria S, Koesnoe S, Hermanadi MI, Ophinni Y, Yamada C, Harimurti K, Sari ANL, Yunihastuti E, Djauzi S. Efficacy, Immunogenicity, and Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:1456. [PMID: 37766132 PMCID: PMC10535431 DOI: 10.3390/vaccines11091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with autoimmune diseases are among the susceptible groups to COVID-19 infection because of the complexity of their conditions and the side effects of the immunosuppressive drugs used to treat them. They might show impaired immunogenicity to COVID-19 vaccines and have a higher risk of developing COVID-19. Using a systematic review and meta-analysis, this research sought to summarize the evidence on COVID-19 vaccine efficacy, immunogenicity, and safety in patients with autoimmune diseases following predefined eligibility criteria. Research articles were obtained from an initial search up to 26 September 2022 from PubMed, Embase, EBSCOhost, ProQuest, MedRxiv, bioRxiv, SSRN, EuroPMC, and the Cochrane Center of Randomized Controlled Trials (CCRCT). Of 76 eligible studies obtained, 29, 54, and 38 studies were included in systematic reviews of efficacy, immunogenicity, and safety, respectively, and 6, 18, and 4 studies were included in meta-analyses for efficacy, immunogenicity, and safety, respectively. From the meta-analyses, patients with autoimmune diseases showed more frequent breakthrough COVID-19 infections and lower total antibody (TAb) titers, IgG seroconversion, and neutralizing antibodies after inactivated COVID-19 vaccination compared with healthy controls. They also had more local and systemic adverse events after the first dose of inactivated vaccination compared with healthy controls. After COVID-19 mRNA vaccination, patients with autoimmune diseases had lower TAb titers and IgG seroconversion compared with healthy controls.
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Affiliation(s)
- Alvina Widhani
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
- Department of Internal Medicine, Universitas Indonesia Hospital, Depok 16424, Indonesia
| | - Anshari Saifuddin Hasibuan
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Retia Rismawati
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Suzy Maria
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Sukamto Koesnoe
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Muhammad Ikrar Hermanadi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Youdiil Ophinni
- Division of Clinical Virology, Center for Infectious Diseases, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan;
- Department of Host Defense, Immunology Frontier Research Center, Osaka University, Osaka 565-0871, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto 606-8304, Japan;
| | - Chika Yamada
- Center for Southeast Asian Studies, Kyoto University, Kyoto 606-8304, Japan;
| | - Kuntjoro Harimurti
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia;
| | - Aldean Nadhyia Laela Sari
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Evy Yunihastuti
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
| | - Samsuridjal Djauzi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (R.R.); (S.M.); (S.K.); (M.I.H.); (A.N.L.S.); (E.Y.); (S.D.)
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Yıldırım R, Oliveira T, Isenberg DA. Approach to vaccination in systemic lupus erythematosus on biological treatment. Ann Rheum Dis 2023; 82:1123-1129. [PMID: 37336639 DOI: 10.1136/ard-2023-224071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
In recent years, treat-to-target strategy and early intervention strategies with immunosuppressive agents have attempted to improve the prognosis and outcome in patients with autoimmune inflammatory rheumatic diseases. However, infectious complications due to side effects of medication remain a major concern in routine practice. In this regard, vaccine immunity and vaccination programmes are of the utmost importance in patients with systemic lupus erythematosus (SLE) in terms of morbidity and mortality. Encouragingly, research investigations have increased exponentially, both in monitoring the vaccines efficacy, and in determining the immune response while patients are on immunosuppression., However, in this biological era in rheumatology, relatively little data have been published investigating these parameters in those receiving biological agents, therefore, no definitive consensus about a vaccination policy for patients with SLE is currently available. In this review, we aim to address what is established about vaccinating patients with SLE on biological agents and discuss potential problems.
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Affiliation(s)
- Reşit Yıldırım
- Rheumatology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Tatiana Oliveira
- Internal Medicine Unit, Department of Medicine, Hospital de Cascais, Cascais, Portugal
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Koehm M, Klippstein M, Dauth S, Hallmann K, Kohmer N, Burkhardt H, Ciesek S, Geisslinger G, Rabenau HF, Behrens F. Impact of different classes of immune-modulating treatments on B cell-related and T cell-related immune response before and after COVID-19 booster vaccination in patients with immune-mediated diseases and primary immunodeficiency: a cohort study. RMD Open 2023; 9:e003094. [PMID: 37652553 PMCID: PMC10476126 DOI: 10.1136/rmdopen-2023-003094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/23/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES To evaluate the potential of immunosuppressed patients to mount B-cell and T-cell responses to COVID-19 booster vaccination (third vaccination). METHODS Patients with primary immunodeficiency (PID), immune-mediated inflammatory diseases (IMIDs) on CD20-depleting treatment with rituximab (RTX), or IMIDs treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological disease-modifying antirheumatic drug (bDMARDs) were included and assessed before (baseline visit (BL)) and 2, 4 and 8 weeks after COVID-19 booster vaccination. Serum B-cell responses were assessed by antibody levels against SARS-CoV-2 spike protein (anti-spike IgG antibody (S-AB)) and a surrogate virus neutralisation test (sVNT). T-cell responses were assessed by an interferon gamma release assay (IGRA). RESULTS Fifty patients with PID (n=6), treated with RTX therapy (n=13), or treated with csDMARDs/bDMARDs (n=31) were included. At BL, anti-S-AB titres in PID and csDMARD/bDMARD-treated patients were low (although significantly higher than RTX patients); measures of B-cell-mediated response increased significantly after booster vaccination. In the RTX cohort, low BL anti-S-AB and sVNT values did not improve after booster vaccination, but patients had significantly elevated IGRA responses post booster vaccination compared with the other groups. csDMARD/bDMARD-treated patients showed the highest BL values in all three assays with greater increases in all parameters after booster vaccination compared with patients with PID. CONCLUSION Patients with IMID on therapeutic B-cell depletion have low anti-S-AB and sVNT values before and after booster vaccination but show significantly higher levels of IGRA compared with other immunosuppressed patients, suggesting an underlying mechanism attempting to compensate compromised humoral immunity by upregulating T-cell responsiveness. PID appears to have a stronger impact on antiviral immune response than csDMARD/bDMARD treatment.
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Affiliation(s)
- Michaela Koehm
- Department of Rheumatology, Goethe University, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Maximilian Klippstein
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Stephanie Dauth
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Konstantin Hallmann
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Niko Kohmer
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Harald Burkhardt
- Department of Rheumatology, Goethe University, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Sandra Ciesek
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
- Virology, German Centre for Infection Research, Frankfurt am Main, Germany
| | - Gerd Geisslinger
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Holger F Rabenau
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Frank Behrens
- Department of Rheumatology, Goethe University, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
- Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
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Kale A, Lech M, Anders HJ, Gaikwad AB. Lupus Nephritis: New and Emerging Biologic and Targeted Therapies. BioDrugs 2023:10.1007/s40259-023-00597-3. [PMID: 37093522 DOI: 10.1007/s40259-023-00597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 04/25/2023]
Abstract
Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE), a polyclonal systemic autoimmunity directed against nuclear and other self-antigens. SLE/LN affects mostly females during childbearing age, which puts them at risk for the progression of chronic kidney disease (CKD), cardiovascular disease, and pregnancy complications. The current management of LN involves the use of drugs with significant toxicities, and despite many attempts at novel drug interventions, the overall treatment efficacy has remained low. In this article, we discuss recent drug approvals and the upcoming pipeline of novel medications tested in clinical trials to improve effectiveness in terms of LN disease activity, LN relapse, and progression of LN-related CKD. In this context, we discuss (1) drugs with the potential to achieve these treatment goals by modulating SLE activity as the driving force for LN (e.g., belimumab, obinutuzumab, anifrolumab, and others); (2) drugs with SLE-non specific renoprotective effects by targeting non-immune mechanisms of LN progression (dapagliflozin, empagliflozin); and (3) drugs with dual immunosuppressive and antiproteinuric effects (voclosporin). Increasing the number of possible drug options will help to improve the management of LN in terms of efficacy and safety, and enable a more personalized treatment approach.
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Affiliation(s)
- Ajinath Kale
- Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Pilani, Rajasthan, 333 031, India
| | - Maciej Lech
- Division of Nephrology, Department of Internal Medicine IV, Hospital of the Ludwig Maximilians University Munich, 80336, Munich, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Internal Medicine IV, Hospital of the Ludwig Maximilians University Munich, 80336, Munich, Germany
| | - Anil Bhanudas Gaikwad
- Laboratory of Molecular Pharmacology, Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Pilani, Rajasthan, 333 031, India.
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Schiavoni I, Olivetta E, Natalucci F, Olivieri G, Lo Presti A, Fedele G, Stefanelli P, Ceccarelli F, Conti F. Evidence of immune response to BNT162b2 COVID-19 vaccine in systemic lupus erythematosus patients treated with Belimumab. Lupus 2023; 32:394-400. [PMID: 36607313 PMCID: PMC9833998 DOI: 10.1177/09612033221151012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate humoral and cell-mediated response after three doses of BNT162b2 SARS-CoV-2 vaccine in patients with systemic lupus erythematosus (SLE) treated with Belimumab (BLM). METHODS SLE patients were vaccinated with three doses of BNT162b2-mRNA vaccine (two-dose primary vaccination, third booster dose after 6 months). The humoral immune response was assessed one and 6 months after the second dose (T1, T2), and 6 months after the booster dose (T3). Serological assay was performed (The Liaison® SARS-CoV-2 TrimericS IgG chemiluminescent). Spike-specific T-cell response was monitored 6 months after the second vaccine dose and the percentage of cytokines producing T cells was assessed by flow cytometry. RESULTS Twelve patients [12F; median age 46 years (IQR 8.25); median disease duration 156 months (IQR 188)] were enrolled. At T1, all patients showed seroconversion (median anti-Spike IgG levels 1610 BAU/mL, IQR 1390). At T2--day of the third dose--a significant reduction of median anti-Spike IgG antibodies levels was observed [214 BAU/mL (IQR 94); p = 0.0009]. Anti-Spike IgG were significantly increased at T3, reaching a median value of 1440 BAU/mL (IQR 1316; p = 0.005). Despite declining humoral immunity, almost 60% of patients mounted a virus-specific CD4 + T-cell response 6 months after primary vaccination. CONCLUSIONS BLM does not impair humoral response to primary BNT162b2 SARS-CoV-2 vaccination. During the follow-up, a decline in antibody levels is evident and the third dose is crucial to increase the specific immune response. Finally, we observed a recall T-cell response to the Spike antigen 6 months after the first vaccination cycle.
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Affiliation(s)
- Ilaria Schiavoni
- Department of Infectious Disease, 9289Istituto Superiore di Sanità, Rome, Italy
| | - Eleonora Olivetta
- Department of Infectious Disease, 9289Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Natalucci
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, 9311Sapienza Università di Roma, Rome, Italy
| | - Giulio Olivieri
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, 9311Sapienza Università di Roma, Rome, Italy
| | | | - Giorgio Fedele
- Department of Infectious Disease, 9289Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Disease, 9289Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, 9311Sapienza Università di Roma, Rome, Italy
| | - Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, 9311Sapienza Università di Roma, Rome, Italy
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Quartuccio L, De Marchi G, Domenis R, Cabas N, Guella S, Paradiso A, Fabro C, Beltrami AP, De Vita S, Curcio F. Humoral and T-Cell Mediated Response after the Third Dose of mRNA Vaccines in Patients with Systemic Lupus Erythematosus on Belimumab. J Clin Med 2023; 12:jcm12031083. [PMID: 36769731 PMCID: PMC9917399 DOI: 10.3390/jcm12031083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To evaluate humoral and T-cell cellular-mediated immune response after three doses of SARS-CoV-2 mRNA vaccines in patients with systemic lupus erythematosus (SLE) under Belimumab. PATIENTS AND METHODS 12 patients on Belimumab and 13 age-matched healthy volunteers were recruited. Patients were in remission or in low disease activity, and they were taking no corticosteroids or only low doses. None of the patients and controls had detectable anti-SARS-CoV-2 antibodies due to previous exposure to the virus. All the patients received three doses of mRNA anti-SARS-CoV-2 vaccines and the humoral and cellular-mediated response were tested 4 weeks after the second dose (T0), 6 months after the second dose (T1) and 4 weeks after the third dose (T2). Comparison with the control group was performed at time T0 (i.e., 4 weeks after the second dose). Total anti-SARS-CoV-2 RBD antibodies were analyzed using a diagnostic assay, while cellular-mediated response was evaluated using the interferon-gamma release assay (IGRA). RESULTS A humoral response was documented in all the patients at T0 (median 459; IQR 225.25-758.5), but the antibody titer significantly declined from T0 to T1 (median 44.7; IQR: 30.3-202; p = 0.0066). At T2, the antibody titer significantly increased from T1 (median 2500; IQR: 2500-2500), and it was not different from T0 (respectively p < 0.0001, p = 0.66). Cellular-mediated response significantly declined from T0 to T1 (p = 0.003) but not from T0 to T2 (p = 0.3). No differences were found between patients and controls at T0 as regards both humoral and cellular responses (p = 1.0 and p = 0.09 for humoral and cellular responses, respectively). CONCLUSION The third dose of mRNA COVID-19 vaccine can restore both humoral and cellular immune response in SLE patients on Belimumab.
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Affiliation(s)
- Luca Quartuccio
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Correspondence: (L.Q.); (G.D.M.)
| | - Ginevra De Marchi
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Correspondence: (L.Q.); (G.D.M.)
| | - Rossana Domenis
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Nicola Cabas
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Silvia Guella
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Antonella Paradiso
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Cinzia Fabro
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Antonio Paolo Beltrami
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Salvatore De Vita
- Division of Rheumatology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Francesco Curcio
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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9
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Egri N, Calderón H, Martinez R, Vazquez M, Gómez-Caverzaschi V, Pascal M, Araújo O, Juan M, González-Navarro EA, Hernández-Rodríguez J. Cellular and humoral responses after second and third SARS-CoV-2 vaccinations in patients with autoimmune diseases treated with rituximab: specific T cell immunity remains longer and plays a protective role against SARS-CoV-2 reinfections. Front Immunol 2023; 14:1146841. [PMID: 37180097 PMCID: PMC10174323 DOI: 10.3389/fimmu.2023.1146841] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
Background Humoral and cellular immune responses are known to be crucial for patients to recover from COVID-19 and to protect them against SARS-CoV-2 reinfection once infected or vaccinated. Objectives This study aimed to investigate humoral and T cell responses to SARS-CoV-2 vaccination in patients with autoimmune diseases after the second and third vaccine doses while on rituximab and their potential protective role against reinfection. Methods Ten COVID-19-naïve patients were included. Three time points were used for monitoring cellular and humoral responses: pre-vaccine to exclude virus exposure (time point 1) and post-second and post-third vaccine (time points 2 and 3). Specific IgG antibodies were monitored by Luminex and T cells against SARS-CoV-2 spike-protein by ELISpot and CoVITEST. All episodes of symptomatic COVID-19 were recorded. Results Nine patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and one with an undifferentiated autoimmune disease were included. Nine patients received mRNA vaccines. The last rituximab infusion was administered for a mean (SD) of 15 (10) weeks before the first vaccine and six patients were CD19-B cell-depleted. After a mean (SD) of 19 (10) and 16 (2) days from the second and third vaccine dose, IgG anti-SARS-CoV-2 antibodies were detected in six (60%) and eight (80%) patients, respectively. All patients developed specific T cell responses by ELISpot and CoVITEST in time points 2 and 3. Previous B cell depletion correlated with anti-SARS-CoV-2 IgG levels. Nine (90%) patients developed mild COVID-19 after a median of 7 months of the third dose. Conclusion Rituximab in patients with autoimmune diseases reduces humoral responses but does not avoid the development of T cell responses to SARS-CoV-2 vaccination, which remain present after a booster dose. A steady cellular immunity appears to be protective against subsequent reinfections.
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Affiliation(s)
- Natalia Egri
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET); Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - Hugo Calderón
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET); Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - Robert Martinez
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET); Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - Mario Vazquez
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET); Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - Verónica Gómez-Caverzaschi
- Clinical Unit of Autoinflammatory Diseases and Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - Mariona Pascal
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET); Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - Olga Araújo
- Clinical Unit of Autoinflammatory Diseases and Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - Manel Juan
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET); Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - Europa Azucena González-Navarro
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET); Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
| | - José Hernández-Rodríguez
- Clinical Unit of Autoinflammatory Diseases and Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) and ERN on Connective Tissue and Musculoskeletal Diseases (ReCONNET), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d’Unitats d’Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Autoimmune Diseases and Primary Immunodeficiencies, Barcelona, Spain
- *Correspondence: José Hernández-Rodríguez,
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10
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Zhang-Sun J, Kirou RA, Kirou KA. Low Peripheral B-Cell Counts in Patients With Systemic Rheumatic
Diseases Due to Treatment With Belimumab and/or Rituximab Are Associated With
Low Antibody Responses to Primary COVID-19 Vaccination. HSS J 2022; 19:180-186. [PMID: 37051614 PMCID: PMC9760510 DOI: 10.1177/15563316221142846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022]
Abstract
Background: Immunosuppressive agents inhibit COVID-19 vaccine
antibody (Ab) responses in patients with systemic rheumatic diseases. Rituximab
may fully block Ab responses when B cells become undetected. The effect of
detected but low number of B cells due to treatment with a B-cell agent
(belimumab and/or rituximab) has not been established. Purpose:
We sought to examine whether there is an association between a low number of B
cells due to treatment with belimumab and/or rituximab and impaired primary
COVID-19 vaccination spike Ab responses in patients with systemic rheumatic
diseases. Methods: We retrospectively examined Ab responses to
COVID-19 vaccinations, especially in relation to B-cell counts after treatment
with belimumab and/or rituximab, in 58 patients with systemic rheumatic
diseases: 22 on and 36 not on B-cell agents. We used Kruskal-Wallis and
Mann-Whitney U tests for comparison of Ab values between the
groups and Fisher exact test for relative risk calculations.
Results: Median (interquartile range) postvaccination Ab
responses were lower in patients on versus those not on B-cell agents: 3.91
(0.77–20.00) versus 20.00 (14.32–20.00), respectively. Among patients on
belimumab and/or rituximab, Ab responses of less than 25% of the assay’s upper
limit were exclusively observed in those with B-cell counts lower than 40/µL.
Patients with B-cell counts lower than 40/µL exhibit a relative risk of 6.092
(95% CI: 2.75–14.24) for Ab responses of less than 25% of the upper limit
compared with patients not on B-cell agents. This relative risk remained
significant, even after excluding patients with undetected B cells.
Conclusion: This retrospective study found an association
between low B-cell counts (less than 40/µL) and decreased Ab responses to
primary COVID-19 vaccination in patients with systemic rheumatic diseases
treated with belimumab and/or rituximab. Despite the small number of patients
studied, these findings add to the accumulating evidence on the importance of
B-cell count in predicting spike Ab responses to COVID-19 vaccination.
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Affiliation(s)
| | | | - Kyriakos A. Kirou
- Hospital for Special Surgery, New York,
NY, USA
- Weill Cornell Medicine, New York, NY,
USA
- Kyriakos A. Kirou, MD, Hospital for Special
Surgery, 535 East 70th Street, New York, NY 10021, USA.
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11
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Geisen UM, Rose R, Neumann F, Ciripoi M, Vullriede L, Reid HM, Berner DK, Bertoglio F, Hoff P, Hust M, Longardt AC, Lorentz T, Martini GR, Saggau C, Schirmer JH, Schubert M, Sümbül M, Tran F, Voß M, Zeuner R, Morrison PJ, Bacher P, Fickenscher H, Gerdes S, Peipp M, Schreiber S, Krumbholz A, Hoyer BF. The long term vaccine-induced anti-SARS-CoV-2 immune response is impaired in quantity and quality under TNFα blockade. J Med Virol 2022; 94:5780-5789. [PMID: 35945627 PMCID: PMC9538219 DOI: 10.1002/jmv.28063] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 01/06/2023]
Abstract
The humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in patients with chronic inflammatory disease (CID) declines more rapidly with tumor necrosis factor-α (TNF-α) inhibition. Furthermore, the efficacy of current vaccines against Omicron variants of concern (VOC) including BA.2 is limited. Alterations within immune cell populations, changes in IgG affinity, and the ability to neutralize a pre-VOC strain and the BA.2 virus were investigated in these at-risk patients. Serum levels of anti-SARS-CoV-2 IgG, IgG avidity, and neutralizing antibodies (NA) were determined in anti-TNF-α patients (n = 10) and controls (n = 24 healthy individuals; n = 12 patients under other disease-modifying antirheumatic drugs, oDMARD) before and after the second and third vaccination by ELISA, immunoblot and live virus neutralization assay. SARS-CoV-2-specific B- and T cell subsets were analysed by multicolor flow cytometry. Six months after the second vaccination, anti-SARS-CoV-2 IgG levels, IgG avidity and anti-pre-VOC NA titres were significantly reduced in anti-TNF-α recipients compared to controls (healthy individuals: avidity: p ≤ 0.0001; NA: p = 0.0347; oDMARDs: avidity: p = 0.0012; NA: p = 0.0293). The number of plasma cells was increased in anti-TNF-α patients (Healthy individuals: p = 0.0344; oDMARDs: p = 0.0254), while the absolute number of SARS-CoV-2-specific plasma cells 7 days after 2nd vaccination were comparable. Even after a third vaccination, these patients had lower anti-BA.2 NA titres compared to both other groups. We show a reduced SARS-CoV-2 neutralizing capacity in patients under TNF-α blockade. In this cohort, the plasma cell response appears to be less specific and shows stronger bystander activation. While these effects were observable after the first two vaccinations and with older VOC, the differences in responses to BA.2 were enhanced.
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Affiliation(s)
- Ulf Martin Geisen
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Ruben Rose
- Institute for Infection Medicine, Christian‐Albrecht University of Kiel and University Medical Center Schleswig‐HolsteinKielGermany
| | | | - Maria Ciripoi
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Lena Vullriede
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Hayley M. Reid
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Dennis Kristopher Berner
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Federico Bertoglio
- Department of BiotechnologyInstitute of Biochemistry, Biotechnology, and Bioinformatics, Technische Universität BraunschweigBraunschweigGermany
| | - Paula Hoff
- Department of Rheumatology, Endokrinologikum‐GruppeBerlinGermany
| | - Michael Hust
- Department of BiotechnologyInstitute of Biochemistry, Biotechnology, and Bioinformatics, Technische Universität BraunschweigBraunschweigGermany
| | | | | | - Gabriela Rios Martini
- Institute of ImmunologyUniversity Medical Center Schleswig‐HolsteinKielGermany,Department for DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Carina Saggau
- Institute of ImmunologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Jan Henrik Schirmer
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Maren Schubert
- Department of BiotechnologyInstitute of Biochemistry, Biotechnology, and Bioinformatics, Technische Universität BraunschweigBraunschweigGermany
| | - Melike Sümbül
- Department for DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Florian Tran
- Institute of Clinical Molecular BiologyChristian‐Albrecht University of KielKielGermany,Department for Internal Medicine IUniversity Medical Center Schleswig‐HolsteinKiel
| | - Mathias Voß
- Institute for Infection Medicine, Christian‐Albrecht University of Kiel and University Medical Center Schleswig‐HolsteinKielGermany
| | - Rainald Zeuner
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Peter J. Morrison
- Department for DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Petra Bacher
- Institute of ImmunologyUniversity Medical Center Schleswig‐HolsteinKielGermany,Institute of Clinical Molecular BiologyChristian‐Albrecht University of KielKielGermany
| | - Helmut Fickenscher
- Institute for Infection Medicine, Christian‐Albrecht University of Kiel and University Medical Center Schleswig‐HolsteinKielGermany
| | - Sascha Gerdes
- Department for DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Matthias Peipp
- Department of Internal Medicine II, Division of Antibody‐Based ImmunotherapyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Stefan Schreiber
- Institute of Clinical Molecular BiologyChristian‐Albrecht University of KielKielGermany,Department for Internal Medicine IUniversity Medical Center Schleswig‐HolsteinKiel
| | - Andi Krumbholz
- Institute for Infection Medicine, Christian‐Albrecht University of Kiel and University Medical Center Schleswig‐HolsteinKielGermany,Labor Dr. Krause und Kollegen MVZ GmbHKielGermany
| | - Bimba Franziska Hoyer
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
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12
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Boedecker-Lips SC, Claßen P, Kraus D, Weinmann-Menke J. Belimumab is not associated with COVID-19 mRNA vaccination failure in systemic lupus erythematosus. Rheumatology (Oxford) 2022; 62:e34-e35. [PMID: 35972412 PMCID: PMC9384795 DOI: 10.1093/rheumatology/keac459] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Paul Claßen
- 1st Department of Medicine, University Medical Center, Mainz, Germany
| | | | - Julia Weinmann-Menke
- To whom correspondence should be addressed: Prof. Dr. med. Julia Weinmann-Menke, I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; phone +49 6131 17-2462, fax +49 6131 17-8471,
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13
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Mahroum N, Elsalti A, Alwani A, Seida I, Alrais M, Seida R, Esirgun SN, Abali T, Kiyak Z, Zoubi M, Shoenfeld Y. The mosaic of autoimmunity - Finally discussing in person. The 13 th international congress on autoimmunity 2022 (AUTO13) Athens. Autoimmun Rev 2022; 21:103166. [PMID: 35932955 PMCID: PMC9349027 DOI: 10.1016/j.autrev.2022.103166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Abstract
While autoimmunity is a branch of medicine linked to every single organ system via direct and indirect pathways, meeting in person to discuss autoimmunity during the 13th international congress on autoimmunity (AUTO13) with participants from all over the world had a very good reason. The mechanisms involved in autoimmune diseases are of extreme importance and in fact critical in understanding the course of diseases as well as selecting proper therapies. COVID-19 has served as a great example of how autoimmunity is deeply involved in the disease and directly correlated to severity, morbidity, and mortality. For instance, initially the term cytokine storm dominated, then COVID-19 was addressed as the new member of the hyperferritinemic syndrome, and also the use of immunosuppressants in patients with COVID-19 throughout the pandemic, all shed light on the fundamental role of autoimmunity. Unsurprisingly, SARS-CoV-2 was called the “autoimmune virus” during AUTO13. Subsequently, the correlation between autoimmunity and COVID-19 vaccines and post-COVID, all were discussed from different autoimmune aspects during the congress. In addition, updates on the mechanisms of diseases, autoantibodies, novel diagnostics and therapies in regard to autoimmune diseases such as antiphospholipid syndrome, systemic lupus erythematosus, systemic sclerosis and others, were discussed in dedicated sessions. Due to the magnificence of the topics discussed, we aimed to bring in our article hereby, the pearls of AUTO13 in terms of updates, new aspects of autoimmunity, and interesting findings. While more than 500 abstract were presented, concluding all the topics was not in reach, hence major findings were summarized.
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Affiliation(s)
- Naim Mahroum
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
| | - Abdulrahman Elsalti
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Abdulkarim Alwani
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Isa Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mahmoud Alrais
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ravend Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Sevval Nil Esirgun
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Tunahan Abali
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Zeynep Kiyak
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Majdi Zoubi
- Department of Internal Medicine B, HaEmek Medical Center, Afula, Israel, Affiliated to Technion, Faculty of Medicine, Haifa, Israel
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14
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Escalera CR, Guisado ÁMZ, Mateo FJ, Bahamontes-Rosa N, Villanueva MJG. Use of belimumab in real-world in Spain: a scoping review about characteristics of SLE patients. Clin Rheumatol 2022; 41:3373-3382. [PMID: 35871173 PMCID: PMC9308486 DOI: 10.1007/s10067-022-06287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
Background Belimumab was the first biological drug approved for Systemic Lupus Erythematosus (SLE). There is not a review focusing on all real-life experience with belimumab to date that could help to describe how this drug behaves in the Spanish clinical setting. Objective To describe the characteristics of SLE patients treated with belimumab added to standard of care in real-clinical setting in Spain. Methods We conducted a comprehensive scoping review of real-world data (RWD) according to PRISMA Scoping Reviews Checklist and the framework proposed by Arksey and O’Malley. PubMed and EMBASE were searched without language restriction and hand searches of relevant articles were examined. Results We included data from 222 patients treated with belimumab for SLE included in 19 RWD studies conducted in Spain. The mean age was 40.9 years, 84.2% were female, and baseline scores SELENA-SLEDAI ranged between 5.9 and 12. Lupus nephritis basal prevalence was of 2.7%. The main reason for belimumab initiation was previous treatments lack of efficacy (69.7%) and the most common laboratory abnormalities were hypocomplementemia (40.9%), ANA + (34.2%), and anti-DNA (33.3%). The addition of belimumab to standard therapy was associated with a reduction of daily glucocorticoids intake in 1.4–11.1 mg at 6 months. Belimumab discontinuation was observed in 18.6% of patients. Conclusion Our study helps to further explore the profile of SLE patients most likely to be treated with belimumab. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-022-06287-9.
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