1
|
Ouyang L, Lei G, Gong Y. Immunogenicity of COVID-19 vaccines in patients with cirrhosis: A meta-analysis. Hum Vaccin Immunother 2024; 20:2326316. [PMID: 38466197 PMCID: PMC10936597 DOI: 10.1080/21645515.2024.2326316] [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: 01/15/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024] Open
Abstract
The immunogenicity of COVID-19 vaccines in patients with liver cirrhosis remains largely unknown. The purpose of this meta-analysis was to investigate the immunogenicity of COVID-19 vaccines in patients with cirrhosis and compare the humoral and cellular immune responses following complete COVID-19 vaccination between cirrhosis patients and healthy controls. A systematic literature search was conducted in PubMed, EMBASE, and Web of Science from 1 January 2020 to 22 August 2023. Sixteen studies with 2127 cirrhosis patients were included. The pooled seroconversion rate in patients with cirrhosis following complete COVID-19 vaccination was 92.4% (95% CI, 86.2%-96%, I2 = 90%) with significant between-study heterogeneity. Moreover, COVID-19 vaccination elicited a higher humoral immune response in patients of compensated cirrhosis as compared with decompensated cirrhosis (RR = 1.069, 95% CI, 1.011-1.131, I2 = 17%, p = .019). Additionally, 10 studies were included for comparison analysis of seroconversion rate between cirrhosis patients and healthy controls. The results showed that the seroconversion rate in patients with cirrhosis was slightly lower compared with healthy controls (RR = 0.972, 95% CI, 0.955-0.989, I2 = 66%, p = .001). Meanwhile, the pooled RR of cellular immune response rate for cirrhosis patients vs. healthy controls was 0.678 (95% CI, 0.563-0.817, I2 = 0, p < .0001). Our meta-analysis demonstrated that COVID-19 vaccination elicited diminished humoral and cellular immune responses in patients of cirrhosis. Patients with cirrhosis particularly decompensated cirrhosis who have completed full-doses of COVID-19 vaccination should receive continuous attention and preemptive measures.
Collapse
Affiliation(s)
- Lichen Ouyang
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, China
| | - Gang Lei
- Department of Obstetric, Centre Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
| | - Yeli Gong
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, China
| |
Collapse
|
2
|
Jilg N, Giganti MJ, Chew KW, Shaw-Saliba K, Ritz J, Moser C, Evering TH, Daar ES, Eron JJ, Currier JS, Hughes MD, Lane HC, Dewar R, Smith DM, Li JZ. Severe Acute Respiratory Syndrome Coronavirus 2 Plasma Antibody and Nucleocapsid Antigen Status Predict Outcomes in Outpatients With Coronavirus Disease 2019. Clin Infect Dis 2024:ciae324. [PMID: 39018444 DOI: 10.1093/cid/ciae324] [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: 05/22/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Reliable biomarkers of coronavirus disease 2019 (COVID-19) outcomes are critically needed. We evaluated associations of spike antibody (Ab) and plasma nucleocapsid antigen (N Ag) with clinical outcomes in nonhospitalized persons with mild-to-moderate COVID-19. METHODS Participants were nonhospitalized adults with mild-to-moderate COVID-19 enrolled in ACTIV-2 between January and July 2021 and randomized to placebo. We used quantitative assays for severe acute respiratory syndrome coronavirus 2 spike Ab and N Ag in blood and determined numbers of hospitalization/death events within 28 days and time to symptom improvement. RESULTS Of 209 participants, 77 (37%) had quantifiable spike Ab and 139 (67%) quantifiable N Ag. Median age was 50 years; 111 (53%) were female, 182 (87%) White, and 105 (50%) Hispanic/Latino. Higher risk of hospitalization/death was seen with unquantifiable (22/132 [16.7%]) versus quantifiable (1/77 [1.3%]) spike Ab (risk ratio [RR], 12.83 [95% confidence interval {CI}, 1.76-93.34]) and quantifiable (22/139 [15.8%]) vs unquantifiable (1/70 [1.4%]) N Ag (RR, 11.08 [95% CI, 1.52-80.51]). Increasing risk of hospitalizations/deaths was seen with increasing N Ag levels. Time to symptom improvement was longer with unquantifiable versus quantifiable spike Ab (median, 14 [interquartile range {IQR}, 8 to >27] vs 8 [IQR, 4-22] days; adjusted hazard ratio [aHR], 0.66 [95% CI, .45-.96]) and with quantifiable versus unquantifiable N Ag (median, 12 [7 to >27] vs 10 [5-22] days; aHR, 0.79 [95% CI, .52-1.21]). CONCLUSIONS Absence of spike Ab and presence of plasma N Ag predicted hospitalization/death and delayed symptom improvement in COVID-19 outpatients.
Collapse
Affiliation(s)
- Nikolaus Jilg
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark J Giganti
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kara W Chew
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Katy Shaw-Saliba
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Justin Ritz
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carlee Moser
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Teresa H Evering
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Eric S Daar
- Division of HIV Medicine, The Lundquist Institute, University of California, Los Angeles Center, Torrance, California, USA
| | - Joseph J Eron
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Judith S Currier
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Michael D Hughes
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - H Cliff Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Robin Dewar
- Virus Isolation and Serology Laboratory, Frederick National Laboratory, Frederick, Maryland, USA
| | - Davey M Smith
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Jonathan Z Li
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Bhella S, Wilkin AM, Hueniken K, Vijenthira A, Sebag M, Wang P, Hicks LK, Hay AE, Assouline S, Fraser G, Balitsky A, Mangel J, Owen C, Reiman A, Sehn L, Sutherland H, Zhang T, Arnold C, Leite T, McCarthy E, Cooper C, Langlois MA, Arianne Buchan C. COVID-19 vaccine immunogenicity and safety surrounding fourth and subsequent vaccine doses in patients with hematologic malignancies. Vaccine 2024:S0264-410X(24)00715-1. [PMID: 38944577 DOI: 10.1016/j.vaccine.2024.06.041] [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: 02/29/2024] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Immune response to COVID-19 vaccine is diminished in patients with hematologic malignancy. There is limited data regarding response to vaccine doses in these patients. PURPOSE To quantify the humoral immune response engendered by 4th and subsequent doses of SARS-CoV-2 vaccination as measured by anti-Spike (anti-S) antibody levels, based on dried blood spot (DBS) testing, in patients with hematologic malignancies. Anti-S binds to the spike protein of the SARS-CoV-2 virus and is indicative of vaccine immunogenicity. METHODS We conducted a prospective study of hematologic malignancies between August 2021 and January 2023 at 12 sites across Canada. Participants were followed longitudinally and submitted finger-prick DBS cards at set intervals associated with vaccination. Samples were processed via high throughput ELISA assay to detect serum antibodies against nucleocapsid (N) and spike (S) proteins. RESULTS We obtained 3071 samples on 790 unique patients. Of these, 372 unique participants with 1840 samples had anti-S results available post-4th, 5th or 6th COVID-19 vaccine dose and were included for analysis. Three hundred thirty-three patients of the 372 participants submitted a DBS sample post 4th dose. Of these, 257 patients (77.2%) had a positive anti-S antibody. A total of 198 patients had paired samples pre- and post-dose 4, of which 59 (29.7%) had a negative anti-S antibody pre-dose 4. Of these, 20 (33.4%) developed positive anti-S antibody post-dose 4. One hundred forty-nine patients submitted a DBS sample post-dose 5. Of these, 135 patients (90.6%) had positive anti-S antibody. A total of 52 had paired samples pre- and post-dose 5. Six (8.7%) had a negative anti-S antibody pre-dose 5, of which two (33.3%) developed positive anti-S antibody post-dose 5. Of these 372 patients, 123 (34%) reported COVID-19 infection and 4 (1%) had a COVID-19 related hospitalization. There were no reported deaths from COVID-19. CONCLUSIONS This prospective cohort study showed that humoral immune response improved with subsequent doses of COVID-19 vaccines.
Collapse
Affiliation(s)
- Sita Bhella
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada.
| | | | - Katrina Hueniken
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada
| | - Abi Vijenthira
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada
| | - Michael Sebag
- McGill University Health Centre, Montreal, QC, Canada
| | - Peng Wang
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lisa K Hicks
- Division of Hematology/Oncology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | - Graeme Fraser
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Amaris Balitsky
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Joy Mangel
- Division of Hematology, Department of Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Carolyn Owen
- University of Calgary, Tom Baker Cancer Centre, Division of Hematology and Hematological Malignancies, Calgary, AB, Canada
| | - Anthony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, NB, Canada
| | - Laurie Sehn
- BC Cancer Centre for Lymphoma Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Heather Sutherland
- Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, BC Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Tinghua Zhang
- Ottawa Hospital Research Institute, Ottawa ON, Canada
| | - Corey Arnold
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Tamara Leite
- Ottawa Hospital Research Institute, Ottawa ON, Canada
| | - Erinn McCarthy
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada
| | - Curtis Cooper
- Ottawa Hospital Research Institute, Ottawa ON, Canada
| | - Marc-Andre Langlois
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | | |
Collapse
|
4
|
Knight SR, O’Callaghan JM, Fallon J. Transplant Trial Watch. Transpl Int 2024; 37:13360. [PMID: 38979121 PMCID: PMC11228962 DOI: 10.3389/ti.2024.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 07/10/2024]
Affiliation(s)
- Simon R. Knight
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Oxford Transplant Centre, Churchill Hospital, Oxford, United Kingdom
| | - John M. O’Callaghan
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- University Hospitals Coventry & Warwickshire, Coventry, United Kingdom
| | - John Fallon
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
5
|
Leacy EJ, Teh JW, O’Rourke AM, Brady G, Gargan S, Conlon N, Scott J, Dunne J, Phelan T, Griffin MD, Power J, Mooney A, Naughton A, Kiersey R, Gardiner M, O’Brien C, Mullan R, Flood R, Clarkson M, Townsend L, O’Shaughnessy M, Dyer AH, Moran B, Fletcher JM, Zgaga L, Little MA. Effect of Immunosuppression on the Immune Response to SARS-CoV-2 Infection and Vaccination. Int J Mol Sci 2024; 25:5239. [PMID: 38791279 PMCID: PMC11120762 DOI: 10.3390/ijms25105239] [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: 04/03/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Immunosuppressive treatment in patients with rheumatic diseases can maintain disease remission but also increase risk of infection. Their response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is frequently blunted. In this study we evaluated the effect of immunosuppression exposure on humoral and T cell immune responses to SARS-CoV-2 infection and vaccination in two distinct cohorts of patients; one during acute SARS-CoV-2 infection and 3 months later during convalescence, and another prior to SARS-CoV-2 vaccination, with follow up sampling 6 weeks after vaccination. Results were compared between rituximab-exposed (in previous 6 months), immunosuppression-exposed (in previous 3 months), and non-immunosuppressed groups. The immune cell phenotype was defined by flow cytometry and ELISA. Antigen specific T cell responses were estimated using a whole blood stimulation interferon-γ release assay. A focused post-vaccine assessment of rituximab-treated patients using high dimensional spectral cytometry was conducted. Acute SARS-CoV-2 infection was characterised by T cell lymphopenia, and a reduction in NK cells and naïve CD4 and CD8 cells, without any significant differences between immunosuppressed and non-immunosuppressed patient groups. Conversely, activated CD4 and CD8 cell counts increased in non-immunosuppressed patients with acute SARS-CoV-2 infection but this response was blunted in the presence of immunosuppression. In rituximab-treated patients, antigen-specific T cell responses were preserved in SARS-CoV-2 vaccination, but patients were unable to mount an appropriate humoral response.
Collapse
Affiliation(s)
- Emma J. Leacy
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland (G.B.)
| | - Jia Wei Teh
- Department of Nephrology, Galway University Hospital, H91 YR71 Galway, Ireland
| | - Aoife M. O’Rourke
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland; (A.M.O.)
| | - Gareth Brady
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland (G.B.)
| | - Siobhan Gargan
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland (J.D.)
| | - Jennifer Scott
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland (G.B.)
| | - Jean Dunne
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland (J.D.)
| | - Thomas Phelan
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland (G.B.)
| | - Matthew D. Griffin
- Department of Nephrology, Galway University Hospital, H91 YR71 Galway, Ireland
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre for Medical Devices, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Julie Power
- Vasculitis Ireland Awareness, Belfast & Dublin, Ireland
| | - Aoife Mooney
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland (J.D.)
| | - Aifric Naughton
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland (J.D.)
| | - Rachel Kiersey
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland (J.D.)
| | - Mary Gardiner
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland (J.D.)
| | - Caroline O’Brien
- Department of Immunology, St. James’s Hospital, D08 NHY1 Dublin, Ireland (J.D.)
| | - Ronan Mullan
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Rachael Flood
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, D08 W9RT Dublin, Ireland
- Department of Rheumatology, Tallaght University Hospital, D24 NR0A Dublin, Ireland
| | - Michael Clarkson
- Department of Nephrology, Cork University Hospital, T12 DC4A Cork, Ireland
| | - Liam Townsend
- Department of Infectious Diseases, St. James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Michelle O’Shaughnessy
- Department of Nephrology, Galway University Hospital, H91 YR71 Galway, Ireland
- Department of Nephrology, Cork University Hospital, T12 DC4A Cork, Ireland
| | - Adam H. Dyer
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - Barry Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland; (A.M.O.)
| | - Jean M. Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland; (A.M.O.)
| | - Lina Zgaga
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Mark A. Little
- Trinity Kidney Centre, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland (G.B.)
| |
Collapse
|
6
|
Ripoll JG, Tulledge-Scheitel SM, Stephenson AA, Ford S, Pike ML, Gorman EK, Hanson SN, Juskewitch JE, Miller AJ, Zaremba S, Ovrom EA, Razonable RR, Ganesh R, Hurt RT, Fischer EN, Derr AN, Eberle MR, Larsen JJ, Carney CM, Theel ES, Parikh SA, Kay NE, Joyner MJ, Senefeld JW. Outpatient treatment with concomitant vaccine-boosted convalescent plasma for patients with immunosuppression and COVID-19. mBio 2024; 15:e0040024. [PMID: 38602414 PMCID: PMC11078006 DOI: 10.1128/mbio.00400-24] [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: 02/08/2024] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
Although severe coronavirus disease 2019 (COVID-19) and hospitalization associated with COVID-19 are generally preventable among healthy vaccine recipients, patients with immunosuppression have poor immunogenic responses to COVID-19 vaccines and remain at high risk of infection with SARS-CoV-2 and hospitalization. In addition, monoclonal antibody therapy is limited by the emergence of novel SARS-CoV-2 variants that have serially escaped neutralization. In this context, there is interest in understanding the clinical benefit associated with COVID-19 convalescent plasma collected from persons who have been both naturally infected with SARS-CoV-2 and vaccinated against SARS-CoV-2 ("vax-plasma"). Thus, we report the clinical outcome of 386 immunocompromised outpatients who were diagnosed with COVID-19 and who received contemporary COVID-19-specific therapeutics (standard-of-care group) and a subgroup who also received concomitant treatment with very high titer COVID-19 convalescent plasma (vax-plasma group) with a specific focus on hospitalization rates. The overall hospitalization rate was 2.2% (5 of 225 patients) in the vax-plasma group and 6.2% (10 of 161 patients) in the standard-of-care group, which corresponded to a relative risk reduction of 65% (P = 0.046). Evidence of efficacy in nonvaccinated patients cannot be inferred from these data because 94% (361 of 386 patients) of patients were vaccinated. In vaccinated patients with immunosuppression and COVID-19, the addition of vax-plasma or very high titer COVID-19 convalescent plasma to COVID-19-specific therapies reduced the risk of disease progression leading to hospitalization.IMPORTANCEAs SARS-CoV-2 evolves, new variants of concern (VOCs) have emerged that evade available anti-spike monoclonal antibodies, particularly among immunosuppressed patients. However, high-titer COVID-19 convalescent plasma continues to be effective against VOCs because of its broad-spectrum immunomodulatory properties. Thus, we report clinical outcomes of 386 immunocompromised outpatients who were treated with COVID-19-specific therapeutics and a subgroup also treated with vaccine-boosted convalescent plasma. We found that the administration of vaccine-boosted convalescent plasma was associated with a significantly decreased incidence of hospitalization among immunocompromised COVID-19 outpatients. Our data add to the contemporary data providing evidence to support the clinical utility of high-titer convalescent plasma as antibody replacement therapy in immunocompromised patients.
Collapse
Affiliation(s)
- Juan G. Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Anthony A. Stephenson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shane Ford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marsha L. Pike
- Department of Nursing, Mayo Clinic, Rochester, Rochester, Minnesota, USA
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara N. Hanson
- Department of Family Medicine, Mayo Clinic Health Care System, Mankato, Minnesota, USA
| | - Justin E. Juskewitch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alex J. Miller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Solomiia Zaremba
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik A. Ovrom
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymund R. Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T. Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin N. Fischer
- Department of Nursing, Mayo Clinic, Rochester, Rochester, Minnesota, USA
| | - Amber N. Derr
- Division of Hematology and Infusion Therapy, Rochester, Minnesota, USA
| | - Michele R. Eberle
- Mayo Clinic Health System Northwest Wisconsin, Eau Claire, Wisconsin, USA
| | | | | | - Elitza S. Theel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Neil E. Kay
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health and Kinesiology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| |
Collapse
|
7
|
Calabrese C. The Future of COVID-19 for Patients With Immune-Mediated Inflammatory Diseases: Who Is at Risk? J Rheumatol 2024; 51:221-223. [PMID: 38224980 DOI: 10.3899/jrheum.2023-1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Cassandra Calabrese
- C. Calabrese, DO, Cleveland Clinic Lerner College of Medicine, Department of Rheumatologic & Immunologic Disease, Department of Infectious Disease, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA. CC has received speaker fees from Sanofi and AstraZeneca, and consulting fees from Sanofi, AstraZeneca, Pfizer, and Lilly.
| |
Collapse
|
8
|
Schiff AE, Wang X, Patel NJ, Kawano Y, Kowalski EN, Cook CE, Vanni KM, Qian G, Bade KJ, Saavedra AA, Srivatsan S, Williams ZK, Venkat RK, Wallace ZS, Sparks JA. Immunomodulators and risk for breakthrough infection after third COVID-19 mRNA vaccine among patients with rheumatoid arthritis: A cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.08.23296717. [PMID: 37873462 PMCID: PMC10592996 DOI: 10.1101/2023.10.08.23296717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives To investigate COVID-19 breakthrough infection after third mRNA vaccine dose among patients with RA by immunomodulator drug class, and we hypothesized that CD20 inhibitors (CD20i) would have higher risk for breakthrough COVID-19 vs. TNF inhibitors (TNFi). Methods We performed a retrospective cohort study investigating breakthrough COVID-19 among RA patients at Mass General Brigham in Boston, MA, USA. Patients were followed from the date of 3rd vaccine dose until breakthrough COVID-19, death, or end of follow-up (18/Jan/2023). Covariates included demographics, lifestyle, comorbidities, and prior COVID-19. We used Cox proportional hazards models to estimate breakthrough COVID-19 risk by immunomodulator drug class. We used propensity score (PS) overlap-weighting to compare users of CD20i vs. TNFi. Results We analyzed 5781 patients with RA that received 3 mRNA vaccine doses (78.8% female, mean age 64.2 years). During mean follow-up of 12.8 months, 1173 (20.2%) had breakthrough COVID_19. Use of CD20i (adjusted HR 1.74, 95%CI 1.30-2.33) and glucocorticoid monotherapy (adjusted HR 1.47, 95%CI 1.09-1.98) were each associated with breakthrough COVID-19 compared to TNFi use. In the PS overlap-weighted analysis, CD20i users also had higher breakthrough COVID-19 risk than TNFi users (HR 1.62, 95%CI 1.02-2.56). A sensitivity analysis excluding patients with cancer or interstitial lung disease yielded similar findings. Conclusions We identified CD20i and glucocorticoid monotherapy as risk factors for breakthrough COVID-19 among patients with RA after a 3rd vaccine dose. This contemporary study highlights the real-world impact of blunted immune responses in these subgroups and the need for effective risk mitigation strategies.
Collapse
Affiliation(s)
- Abigail E. Schiff
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
| | - Xiaosong Wang
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Naomi J. Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
- Harvard Medical School, Boston, MA
| | - Yumeko Kawano
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
| | - Emily N. Kowalski
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Claire E. Cook
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA (The Mongan Institute, 100 Cambridge Street, Suite 1600, Boston, MA, 02114)
| | - Kathleen M.M. Vanni
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Grace Qian
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Katarina J. Bade
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Alene A. Saavedra
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
| | - Shruthi Srivatsan
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
| | - Zachary K. Williams
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
| | - Rathnam K. Venkat
- Tufts University School of Medicine, Boston, MA, USA (145 Harrison Ave, Boston, MA 02111)
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA (Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114)
- Harvard Medical School, Boston, MA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA (The Mongan Institute, 100 Cambridge Street, Suite 1600, Boston, MA, 02114)
| | - Jeffrey A. Sparks
- ivision of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA (60 Fenwood Road, Boston, MA, 02115)
- Harvard Medical School, Boston, MA
| |
Collapse
|