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Law J, Sorrento C, Saxena A. Vaccination updates and special considerations for systemic lupus erythematosus patients. Curr Opin Rheumatol 2024; 36:148-153. [PMID: 37976046 DOI: 10.1097/bor.0000000000000992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW We review the latest guidelines and note special considerations for systemic lupus erythematosus (SLE) patients when approaching vaccination against SARS-CoV-2, influenza, pneumococcus, herpes zoster, and potentially respiratory syncytial virus (RSV) vaccine in the future. RECENT FINDINGS SLE patients have unique infectious risks due to newer treatments and the nature of the disease itself. It is important to balance the benefit of additional protective immunity from updated vaccines against the possible risk of disease activity exacerbations. SUMMARY It is important to continuously evaluate the safety and immunogenicity of updated vaccines specifically for SLE patients. Additionally, the newly approved RSV vaccine should be considered for this population to reduce severe respiratory illness.
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Affiliation(s)
- Jammie Law
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
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Sim TM, Lahiri M, Ma M, Cheung PPM, Mak A, Fong W, Angkodjojo S, Xu C, Kong KO, Arkachaisri T, Phang KF, Tan TC, Yap QV, Chan YH, Sriranganathan M, Chuah TY, Roslan NE, Poh YJ, Law A, Santosa A, Tay SH. Latent Class Analysis Identifies Distinct Phenotypes of Systemic Lupus Erythematosus Predictive of Flares after mRNA COVID-19 Vaccination: Results from the Coronavirus National Vaccine Registry for ImmuNe Diseases SINGapore (CONVIN-SING). Vaccines (Basel) 2023; 12:29. [PMID: 38250842 PMCID: PMC10819486 DOI: 10.3390/vaccines12010029] [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: 10/18/2023] [Revised: 12/03/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
We recently reported that messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccination was associated with flares in 9% of patients with systemic lupus erythematosus (SLE). Herein, we focused our analysis on patients from a multi-ethnic Southeast Asian lupus cohort with the intention of identifying distinct phenotypes associated with increased flares after mRNA COVID-19 vaccination. METHODS Six hundred and thirty-three SLE patients from eight public healthcare institutions were divided into test and validation cohorts based on healthcare clusters. Latent class analysis was performed based on age, ethnicity, gender, vaccine type, past COVID-19 infection, interruption of immunomodulatory/immunosuppressive treatment for vaccination, disease activity and background immunomodulatory/immunosuppressive treatment as input variables. Data from both cohorts were then combined for mixed effect Cox regression to determine which phenotypic cluster had a higher risk for time to first SLE flare, adjusted for the number of vaccine doses. RESULTS Two clusters were identified in the test (C1 vs. C2), validation (C1' vs. C2') and combined (C1″ vs. C2″) cohorts, with corresponding clusters sharing similar characteristics. Of 633 SLE patients, 88.6% were female and there was multi-ethnic representation with 74.9% Chinese, 14.2% Malay and 4.6% Indian. The second cluster (C2, C2' and C2″) was smaller compared to the first. SLE patients in the second cluster (C2 and C2') were more likely to be male, non-Chinese and younger, with higher baseline disease activity. The second cluster (C2″) had more incident flares (hazard ratio = 1.4, 95% confidence interval 1.1-1.9, p = 0.014) after vaccination. A higher proportion of patients in C2″ had immunomodulatory/immunosuppressive treatment interruption for vaccination as compared to patients in C1″ (6.6% vs. 0.2%) (p < 0.001). CONCLUSION We identified two distinct phenotypic clusters of SLE with different patterns of flares following mRNA COVID-19 vaccination. Caution has to be exercised in monitoring for post-vaccination flares in patients with risk factors for flares such as non-Chinese ethnicity, young age, male gender and suboptimal disease control at the time of vaccination.
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Affiliation(s)
- Tao Ming Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (T.M.S.)
| | - Manjari Lahiri
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Margaret Ma
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Peter Pak-Moon Cheung
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Anselm Mak
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Warren Fong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Stanley Angkodjojo
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Chuanhui Xu
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.X.)
| | - Kok Ooi Kong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.X.)
| | - Thaschawee Arkachaisri
- Duke-NUS Medical School, Singapore 169857, Singapore;
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
| | - Kee Fong Phang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
- Chronic Programme, Alexandra Hospital, Singapore 159964, Singapore
| | - Teck Choon Tan
- Division of Rheumatology, Department of General Medicine, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (Q.V.Y.); (Y.H.C.)
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore; (Q.V.Y.); (Y.H.C.)
| | - Melonie Sriranganathan
- Division of Rheumatology, Department of Medicine, Changi General Hospital, Singapore 529889, Singapore
| | - Tyng Yu Chuah
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Nur Emillia Roslan
- Rheumatology Service, Department of General Medicine, Sengkang General Hospital, Singapore 544886, Singapore
| | - Yih Jia Poh
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
| | - Annie Law
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore; (M.M.); (A.S.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (W.F.); (K.F.P.)
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Calabrese C, Atefi G, Evans KA, Moynihan M, Palmer L, Wu SJ. Risk factors for severe COVID-19 among patients with systemic lupus erythematosus: a real-world analysis of a large representative US administrative claims database, 2020-2021. RMD Open 2023; 9:e003250. [PMID: 37591618 PMCID: PMC10441046 DOI: 10.1136/rmdopen-2023-003250] [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] [Received: 04/25/2023] [Accepted: 07/22/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES To identify risk factors for progression to severe COVID-19 and estimate the odds of severe COVID-19 associated with vaccination among patients with systemic lupus erythematosus (SLE). METHODS This retrospective cohort study identified adults with SLE in the Merative™ MarketScan® Databases. Patients were continuously enrolled the year before 1 April 2020 (baseline) and had a COVID-19 diagnosis between 1 April 2020 and the earliest of death, enrolment end or 31 December 2021. Severe COVID-19 was defined as hospitalisation with a COVID-19 diagnosis. Demographics on 1 April 2020, baseline comorbidities, corticosteroid use ≤30 days before COVID-19 diagnosis and other SLE medication use ≤6 months before COVID-19 diagnosis were assessed. Vaccination was identified by claims for a COVID-19 vaccine or vaccine administration. Backward stepwise logistic regression estimated odds of progression to severe COVID-19 associated with patient characteristics and vaccination. RESULTS Among 2890 patients with SLE with COVID-19, 500 (16.4%) had a COVID-19-related hospitalisation. Significant risk factors for progression to severe COVID-19 included rituximab (OR (95% CI) 2.92 (1.67 to 5.12)), renal failure (2.15 (95% CI 1.56 to 2.97)), Medicaid (vs Commercial; 2.01 (95% CI 1.58 to 2.57)), complicated hypertension (1.96 (95% CI 1.38 to 2.77)) and time of infection, among others. Vaccination had a significant protective effect (0.68(95% CI 0.54 to 0.87)) among all patients with SLE with COVID-19, but the effect was not significant among those with prior use of belimumab, rituximab or corticosteroids. CONCLUSIONS Certain chronic comorbidities and SLE medications increase the odds of progression to severe COVID-19 among patients with SLE, but vaccination confers significant protection. Vaccine effectiveness may be attenuated by SLE treatments. Protective measures such as pre-exposure prophylaxis and booster vaccines should be encouraged among patients with SLE.
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Affiliation(s)
| | - Gelareh Atefi
- US Medical, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, USA
| | - Kristin A Evans
- Real World Data Research and Analytics, Merative, Ann Arbor, Michigan, USA
| | - Meghan Moynihan
- Real World Data Research and Analytics, Merative, Ann Arbor, Michigan, USA
| | - Liisa Palmer
- Real World Data Research and Analytics, Merative, Ann Arbor, Michigan, USA
| | - Sze-Jung Wu
- US Medical, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, USA
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Comparison of Two Commercially Available Interferon-γ Release Assays for T-Cell-Mediated Immunity and Evaluation of Humoral Immunity against SARS-CoV-2 in Healthcare Workers. Diagnostics (Basel) 2023; 13:diagnostics13040637. [PMID: 36832126 PMCID: PMC9955378 DOI: 10.3390/diagnostics13040637] [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: 01/06/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Cellular immunity against SARS-CoV-2 is an important component of the immune response to the virus. At present, two such tests based on interferon-gamma release (interferon-γ release assays, IGRAs) are available-Quan-T-Cell SARS-CoV-2 by EUROIMMUN and T-SPOT.COVID by Oxford Immunotec. In this paper, we compared the results of these two tests in 90 subjects employed at the Public Health Institute Ostrava who had previously undergone COVID-19 infection or were vaccinated against that disease. To the best of our knowledge, this is the first head-to-head comparison of these two tests evaluating T-cell-mediated immunity against SARS-CoV-2. In addition, we also evaluated humoral immunity in the same individuals using the in-house virus neutralization test and IgG ELISA assay. The evaluation yielded similar results for both IGRAs, with Quan-T-Cell appearing to be insignificantly (p = 0.08) more sensitive (all 90 individuals were at least borderline positive) than T-SPOT.COVID (negative results found in five patients). The overall qualitative (presence/absence of immune response) agreement of both tests with virus neutralization test and anti-S IgG was also excellent (close or equal to 100% in all subgroups, with the exception of unvaccinated Omicron convalescents, a large proportion of whom, i.e., four out of six subjects, were IgG negative while at least borderline positive for T-cell-mediated immunity measured by Quan-T). This implies that the evaluation of T-cell-mediated immunity is a more sensitive indicator of immune response than the evaluation of IgG seropositivity. This is true at least for unvaccinated patients with a history of being infected only by the Omicron variant, but also likely for other groups of patients.
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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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Renaudineau Y, Bost C, Abravanel F, Izopet J, Blancher A, Congy N, Treiner E, Sailler L. Glucocorticoids selectively affect the memory T cell response to SARS-Cov2 spike in vaccinated and post-infected patients with systemic lupus erythematosus. J Transl Autoimmun 2023; 6:100200. [PMID: 37038460 PMCID: PMC10076249 DOI: 10.1016/j.jtauto.2023.100200] [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: 02/16/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023] Open
Abstract
Immune response to vaccines and pathogens remains unclear in patients with systemic lupus erythematosus (SLE). To investigate this, a single-center retrospective study was conducted with 47 SLE patients vaccinated against COVID-19, including 13 who subsequently developed an asymptomatic/mild disease. As compared to controls, post-vaccine response against Spike was reduced in SLE patients when considering both memory T-cells in a whole blood interferon gamma release assay (IGRA-S) and IgG anti-Spike antibody (Ab) responses. The SLE-associated defective IGRA-S response was associated with a serum albumin level below 40 g/L and with the use of glucocorticoids, while a defective IgG anti-Spike Ab response was associated with lower levels of anti-dsDNA and anti-SSA/Ro 52 kDa Abs. IGRA-S and IgG anti-Spike responses were independent from SLE activity and clinical phenotype, low complement, hypergammaglobulinemia, and lymphopenia. As compared to controls, SLE patients showed a rapid decay of anti-Spike T-cell memory and stable IgG anti-Spike Ab responses. In conclusion, both T cell and humoral anti-Spike responses were independently affected in our SLE patients cohort, which supports the exploration of both responses in the follow-up of SLE patients and especially in those receiving glucocorticoids.
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Affiliation(s)
- Yves Renaudineau
- Immunology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France
- INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Chloé Bost
- Immunology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France
- INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Florence Abravanel
- INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
- Virology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France
| | - Jacques Izopet
- INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
- Virology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France
| | - Antoine Blancher
- Immunology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France
- CRCT, INSERM UMR 1037, University Toulouse III, Toulouse, France
| | - Nicolas Congy
- Immunology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France
- CRCT, INSERM UMR 1037, University Toulouse III, Toulouse, France
| | - Emmanuel Treiner
- Immunology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France
- INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Laurent Sailler
- Internal Medicine, University Toulouse III, Toulouse, France
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