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Torres-Rufas M, Vicente-Rabaneda EF, Cardeñoso L, Gutierrez A, Bong DA, Valero-Martínez C, Serra López-Matencio JM, García-Vicuña R, González-Gay MA, González-Álvaro I, Castañeda S. Effectiveness and Safety of the COVID-19 Vaccine in Patients with Rheumatoid Arthritis in a Real-World Setting. Vaccines (Basel) 2024; 12:672. [PMID: 38932401 PMCID: PMC11209506 DOI: 10.3390/vaccines12060672] [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: 05/06/2024] [Revised: 06/06/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Novel mechanisms of COVID-19 vaccines raised concern about their potential immunogenicity in patients with rheumatoid arthritis (RA) undergoing immunomodulatory treatments. We designed a retrospective single-center study to investigate their effectiveness and safety in this population, analyzing data from the first vaccination program (December 2020-October 2021). Inclusion criteria were availability of post-vaccination serology and a minimum subsequent follow-up of 6 months. Binding antibody units (BAU/mL) ≥ 7.1 defined an adequate serological response. Post-vaccine COVID-19 incidence and its timing since vaccination, adverse events (AEs), and RA flares were recorded. Adjusted logistic and linear multivariate regression analyses were carried out to identify factors associated with vaccine response. We included 118 patients (87.2% women, age 65.4 ± 11.6 years, evolution 12.0 ± 9.6 years), of whom 95.8% had a complete vaccination schedule. Adequate humoral immunogenicity was achieved in 88.1% of patients and was associated with previous COVID-19 and mRNA vaccines, whereas smoking, aCCP, age, and DMARDs exerted a negative impact. Post-vaccine COVID-19 occurred in 18.6% of patients, a median of 6.5 months after vaccination. Vaccine AE (19.5%) and RA flares (1.7%) were mostly mild and inversely associated with age. Our results suggest that COVID-19 vaccines induce adequate humoral immunogenicity, with an acceptable safety profile in RA patients.
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Affiliation(s)
- María Torres-Rufas
- Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain;
| | - Esther F. Vicente-Rabaneda
- Rheumatology Department, Instituto de Investigación Sanitaria de La Princesa (IIS-Princesa), Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (C.V.-M.); (R.G.-V.); (I.G.-Á.)
| | - Laura Cardeñoso
- Microbiology Department, IIS-Princesa, Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (L.C.); (A.G.)
| | - Ainhoa Gutierrez
- Microbiology Department, IIS-Princesa, Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (L.C.); (A.G.)
| | - David A. Bong
- Instituto Poal de Reumatología, Carrer de Castanyer, 15, Sarrià-Sant Gervasi, 08022 Barcelona, Spain;
- Bellvitge Campus, Universitat de Barcelona, Carrer de la Feixa Llarga, s/n, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Cristina Valero-Martínez
- Rheumatology Department, Instituto de Investigación Sanitaria de La Princesa (IIS-Princesa), Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (C.V.-M.); (R.G.-V.); (I.G.-Á.)
| | - José M. Serra López-Matencio
- Hospital Pharmacy Department, Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain;
| | - Rosario García-Vicuña
- Rheumatology Department, Instituto de Investigación Sanitaria de La Princesa (IIS-Princesa), Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (C.V.-M.); (R.G.-V.); (I.G.-Á.)
| | - Miguel A. González-Gay
- Rheumatology Department, IIS-Fundación Jiménez Díaz, Hospital Universitario Fundación Jiménez Díaz, Avenida de los Reyes Católicos, 2, Moncloa-Aravaca, 28040 Madrid, Spain;
- Medicine and Psychiatry Department, University of Cantabria, 39008 Santander, Spain
| | - Isidoro González-Álvaro
- Rheumatology Department, Instituto de Investigación Sanitaria de La Princesa (IIS-Princesa), Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (C.V.-M.); (R.G.-V.); (I.G.-Á.)
| | - Santos Castañeda
- Rheumatology Department, Instituto de Investigación Sanitaria de La Princesa (IIS-Princesa), Hospital Universitario de La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (C.V.-M.); (R.G.-V.); (I.G.-Á.)
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Garcia-Cirera S, Calvet J, Delgado de la Poza JF, Berenguer-Llergo A, Orellana C, Rusiñol M, Llop M, Arévalo M, Garcia-Pinilla A, Costa E, Aymerich C, Gómez R, Carreras A, Gratacós J. Biological and glucocorticoids treatment impair the medium-term immunogenicity to SARS-CoV-2 mRNA vaccines in autoimmune inflammatory rheumatic diseases. Eur J Med Res 2024; 29:28. [PMID: 38183092 PMCID: PMC10768211 DOI: 10.1186/s40001-023-01620-7] [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: 09/08/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND This study aims to assess the sustained immunological response to the SARS-CoV-2 vaccine in patients with autoimmune inflammatory rheumatic diseases (AIRD) undergoing different treatment regimens. METHODS We conducted a prospective observational study involving 157 AIRD patients without prior COVID-19 infection. Treatment regimens included non-treatment or glucocorticoid-only (not-treated/GCs), non-biological drugs, biological therapy, and JAK inhibitors. All participants completed the two-dose vaccine schedule, and 110 of them received an additional booster dose. Serum samples were collected approximately 3-6 months after the second and third vaccine doses to measure antibodies against the Spike protein (antiS-AB) and neutralizing antibodies (nAB) targeting six SARS-CoV-2 variants. RESULTS Following the third dose, all patients exhibited a significant increase in antiS-AB (FC = 15, p < 0.0001). Patients under biological therapy had lower titres compared to the non-biological (66% decrease, p = 0.038) and the not-treated/GCs group (62% decrease, p = 0.0132), with the latter persisting after the booster dose (86% decrease, p = 0.0027). GC use was associated with lower antiS-AB levels in the biological group (87% decrease, p = 0.0124), although not statistically significant after confounders adjustment. nABs showed the highest positivity rates for the wild-type strain before (50%) and after the booster dose (93%), while the Omicron variant exhibited the lowest rates (11% and 55%, respectively). All variants demonstrated similar positivity patterns and good concordance with antiS-AB (AUCs from 0.896 to 0.997). CONCLUSIONS The SARS-CoV-2 vaccine booster strategy effectively elicited a sustained antibody immune response in AIRD patients. However, patients under biological therapies exhibited a reduced response to the booster dose, particularly when combined with GCs.
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Affiliation(s)
- Silvia Garcia-Cirera
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain
| | - Joan Calvet
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain.
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain.
| | - Juan Francisco Delgado de la Poza
- Immunology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), 08208, Sabadell, Spain
| | - Antoni Berenguer-Llergo
- Rheumatology Department, Biostatistics and Bioinformatics at Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), 08028, Sabadell, Spain
| | - Cristóbal Orellana
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Menna Rusiñol
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Marta Arévalo
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Alba Garcia-Pinilla
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Ester Costa
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Cristina Aymerich
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Rafael Gómez
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Anna Carreras
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain
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Hanberg JS, Fu X, Wang X, Patel NJ, Kawano Y, Schiff A, Kowalski EN, Cook CE, Vanni KMM, Guzzo K, Qian G, Bade KJ, Saavedra A, Venkat R, Srivatsan S, Zhang Y, Sparks JA, Wallace ZS. Effectiveness of a fourth dose of COVID-19 mRNA vaccine in patients with systemic autoimmune rheumatic diseases using disease-modifying antirheumatic drugs: an emulated target trial. THE LANCET. RHEUMATOLOGY 2024; 6:e21-e30. [PMID: 38258675 PMCID: PMC10806341 DOI: 10.1016/s2665-9913(23)00272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Patients with systemic autoimmune rheumatic diseases using disease-modifying antirheumatic drugs (DMARDs) might have blunted responses to COVID-19 vaccines. The initial mRNA vaccine series is defined as three doses for this population and a fourth booster dose is recommended. The effectiveness of the fourth dose in patients with systemic autoimmune rheumatic diseases using DMARDs is not well established. We aimed to assess the effectiveness of receiving versus not receiving a fourth dose of COVID-19 mRNA vaccine using a target trial framework, in a cohort of patients with systemic autoimmune rheumatic diseases receiving DMARD therapy. METHODS We conducted an emulated target trial using observational data from the Mass General Brigham health-care system to compare receiving versus not receiving a fourth mRNA vaccine dose. Analysed patients had systemic autoimmune rheumatic diseases, were prescribed DMARDs, and were eligible for a fourth dose of BNT162b2 or mRNA-1273 vaccines between Jan 16 and June 11, 2022. To account for temporal changes, the study period was divided into 1-week intervals. Fourth-dose-exposed patients were included in a 1-week interval if they received a fourth mRNA dose in that interval; fourth-dose-unexposed patients were eligible for but had not received the fourth dose of the vaccine. The primary outcome was a SARS-CoV-2 infection; the secondary outcome was severe SARS-CoV-2 infection (ie, admission to hospital or death within -3 to +14 days of a positive test). We assessed the effectiveness of the fourth dose using time-stratified, overlap propensity score-weighted Cox regression models. FINDINGS We included 4305 patients, 3126 of whom received a fourth dose of vaccine and 1179 who had not. The median follow-up time was 135 days (IQR 112-154) among patients who had received a fourth dose and 65 days (30-156) among patients who had not received a fourth dose. After overlap weighting in both groups, 1863 (72·7%) of 2563 participants were women, 700 (27·3%) were men, and 2242 (87·5%) were White. Rheumatoid arthritis was present in 1392 (54·3%) of 2563 participants; the most frequent treatments were conventional synthetic DMARDs (1489 [58·1%]) or biological DMARDs (1007 [39·3%]). SARS-CoV-2 infection risk was lower among patients receiving versus not receiving a fourth dose of vaccine (HR 0·59 [95% CI 0·47-0·74]). A fourth dose reduced the risk of admission to hospital or death within -3 to +14 days of SARS-CoV-2 infection (0·35 [0·14-0·85]). INTERPRETATION In this emulated target trial, a fourth dose of COVID-19 mRNA vaccine reduced the risk of SARS-CoV-2 infection and severe COVID-19 among patients with systemic autoimmune rheumatic diseases using DMARDs during the Omicron era. Patients with systemic autoimmune rheumatic diseases should be encouraged to remain up-to-date with COVID-19 vaccinations. FUNDING The National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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Affiliation(s)
- Jennifer S Hanberg
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaosong Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Yumeko Kawano
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Abigail Schiff
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Claire E Cook
- Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Krishan Guzzo
- Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Katarina J Bade
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Alene Saavedra
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Rathnam Venkat
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Shruthi Srivatsan
- Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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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.
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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
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Finckh A, Ciurea A, Raptis CE, Rubbert-Roth A. Susceptibility to COVID-19 and Immunologic Response to Vaccination in Patients With Immune-Mediated Inflammatory Diseases. J Infect Dis 2023; 228:S13-S23. [PMID: 37539758 PMCID: PMC10401619 DOI: 10.1093/infdis/jiad148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/06/2023] [Indexed: 08/05/2023] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) are a highly heterogeneous group of diseases that share a common etiology of immune dysregulation, such as rheumatoid arthritis, inflammatory bowel disease, and psoriasis, among others. It is estimated that the prevalence of IMIDs ranges between 5% and 7% in developed countries. As current management of IMIDs includes the use of immunomodulatory medications, the resulting weakened immune response can increase the risk of infection, including with SARS-CoV-2 (the causative agent of COVID-19) and reduce response to vaccination, placing these individuals at continued risk of severe outcomes from COVID-19. In this article, we summarize the current literature related to COVID-19 outcomes and the immunogenicity and reactogenicity of COVID-19 mRNA vaccination among patients with rheumatologically dominated IMIDs, as well as the effect of immunomodulatory therapies on these outcomes. We conclude by providing current COVID-19 vaccination recommendations for individuals with IMID.
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Affiliation(s)
- Axel Finckh
- Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
- Geneva Centre for Inflammation Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Andrea Rubbert-Roth
- Correspondence: A. Rubbert-Roth, MD, Division of Rheumatology, Cantonal Hospital St. Gallen, Rorschacherstr 95, 9007 St. Gallen, Switzerland ()
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