Comparison of antibody response to two different mRNA Covid-19 vaccines in patients on hemodialysis

Introduction

In hemodialysis patients, coronavirus disease 2019 is associated with high morbidity and mortality. Aim of the study was to evaluate the antibody level against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients treated with two different mRNA-based vaccines, in a multicenter survey.

Patients and methods

Since April 2020, in the 5 participating Centers, periodic screening of all patients with PCR testing has been performed every 2 weeks. The study included two cohorts of patients on maintenance hemodialysis treated with the BNT162b2 or with the mRNA-1273 Covid-19 vaccine. The tests for antibodies against the receptor-binding domain was performed by the anti–SARS-CoV-2 S enzyme immunoassay (Roche Elecsys).

Results

Of the 398 included patients, 303 received the BNT162b2 and 95 the mRNA-1273 vaccine. In patients without previous infection, the median levels of anti-S antibodies were 297 U/mL and 1,032 U/mL for those treated with BNT162b2 or mRNA-1273, respectively (p < 0.001). In patients with previous infection, the median levels of SARS-CoV-2 anti-S antibodies were 7,516 U/mL and 17,495 U/mL for those treated with BNT162b2 or mRNA-1273, respectively (p = 0.005). The Charlson comorbidity index (CCI) was significantly associated with protective levels of anti-spike IgG, with 3.6% of low- or non-responders having a CCI of 2–4 versus 18.9% in those with a CCI of 8 or more. The adjusted OR of developing a sufficient antibody level between the two vaccines was 3.91 (p = 0.0766) in favor of mRNA-1273.

Conclusions

Both of the evaluated mRNA-based vaccines for SARS-CoV-2 showed good efficacy. Preliminary data may data suggest a  higher antibody response to the mRNA-1273 vaccine.

Graphical abstract

Hepatitis B virus vaccine and chronic kidney disease. The advances

BACKGROUND

Hepatitis B is an important agent of liver disease in patients with chronic kidney disease and chronic HBV infection promotes the development of CKD in the adult general population. Patients with CKD have a suboptimal response to various vaccines, and it remains unclear how we boost the immune response of CKD patients to HB vaccine.

STUDY AIMS AND DESIGN

We performed a narrative review to assess the mechanisms of lower immunogenicity of HBV vaccine in CKD population; multiple approaches to improve the response rate of CKD patients to HBV vaccine have been reported. This is a very important topic for nephrologists who often serve as primary case providers for patients with CKD.

RESULTS

The recommended vaccine schedule for CKD patients including those on maintenance dialysis is based on recombinant vaccine, four doses (month 0,1,2, and 6; 40mcg each) by intramuscular route (deltoid muscle). According to RCTs or observational studies, some recombinant vaccines with adjuvants (i.e., HBV-AS02 and HBV-AS04) look promising. HBV-AS04 showed to give better seroprotection rates and durable immune response over extended follow-ups compared with licensed HBV vaccine in CKD patients. The seroprotection rate was 95% (97/102) and 82% (202/248) in pre-dialysis and dialysis patients, respectively, one month after completing vaccine schedule with HBV-AS04. HBV-AS02 was superior to licensed vaccine in terms of seroprotection rate, 76.9% vs. 37.6%.

CONCLUSIONS

We suggest adjuvanted recombinant (HBV-AS04) vaccine (0,1,2 and 3 months; 20 mcg each dose) and post vaccination testing of anti-HBs antibody after vaccination. Booster doses to patients whose anti-HBs titers fall below the seroprotection level (<10IU/mL) during the follow-up are appropriate. The patho-physiologic mechanisms responsible for the poor immunogenicity of HBV vaccine in CKD patients are under active investigation.

INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids

Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids is emerging to be an important cause of morbidity and mortality in patients with current or prior exposure to HBV infection. These patients suffer a dual onslaught of illness: one from the primary disease for which they are receiving the culprit drug that led to HBV reactivation, and the other from HBV reactivation itself. The HBV reactivation not only leads to a compromised liver function, which may culminate into hepatic failure; it also adversely impacts the treatment outcome of the primary illness. Hence, identification of patients at risk of reactivation before starting these drugs, and starting treatment aimed at prevention of HBV reactivation is the best strategy of managing these patients. There are no Indian guidelines on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids for the treatment of rheumatologic conditions, malignancies, inflammatory bowel disease, dermatologic conditions, or solid-organ or bone marrow transplantation. The Indian National Association for Study of the Liver (INASL) had set up a taskforce on HBV in 2016, with a mandate to develop consensus guidelines for management of various aspects of HBV infection, relevant to India. In 2017 the taskforce had published the first INASL guidelines on management of HBV infection in India. In the present guidelines, which are in continuation with the previous guidelines, the issues on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids are addressed.