Second shot COVID-19 vaccine urgently needed for patients treated with immunomodulators

In 17% of patients with immune-mediated inflammatory diseases (IMID) on immunomodulating treatment, no seroconversion occurred after their first dose of SARS-CoV-2 vaccination.

Reassuringly, 99% developed antibodies after their second dose

“We know that healthy subjects have close to a 100% seroconversion 15–35 days after the first vaccine dose, and if we consider seroconversion as a potential surrogate of vaccine efficacy, we could investigate whether this is the case in patients on immunomodulatory drugs,” Dr Ali Al-Janabi (University of Manchester, UK) pointed out1.

The current study included 357 patients on immunomodulators for IMID, among them a great majority with psoriasis (n=290), followed by psoriatic arthritis (n=79), and rheumatoid arthritis (n=48). Some patients had more than 1 diagnosis. Samples were collected ≥10 days after vaccine administration and analysed with immunoassays for antibodies against spike protein S1 to assess the vaccine-induced antibody formation.

Further, a second immunoassay was performed to exclude participants with antibodies against nucleocapsid antigen, originating from a preceding infection. After the first dose of any of the available vaccines, 17% did not demonstrate a positive antibody response. “If we look at some of the baseline variables, we see that as age increases, the percentage of participants with a positive antibody response decreases and this is statistically significant,” Dr Al-Janabi noted.

Regarding different drug classes, the group of patients on biologics had the greatest rate of positive responses (73%), while 69% of the group treated with oral immunomodulators were positive for antibodies, and 61% of participants receiving a combination of both. A logistic regression analysis that took biologic therapy as a reference and adjusted for age, sex, and disease found significantly reduced odds for mounting a positive antibody response, with an adjusted odds ratio (OR) of 0.21 (95% CI 0.05–0.87) only for the cohort of participant with combination treatment of biologic plus immunotherapy.

In further exploring f the sub-categories of IMID treating drugs, methotrexate was associated with a significant reduction in the likelihood of seroconversion (adjusted OR 0.09; 95% CI 0.02–0.56) compared with tumour necrosis factor (TNF) inhibition. After the second vaccination, 192 out of 194 patients were positive for anti-spike antibodies. So, reassuringly 99% of IMID patients on immunomodulation had a positive antibody response after their second vaccination.

“By now, there is an argument to minimise the interval between vaccine doses, since almost everybody seroconverts after the second vaccine dose. There is also an argument for methotrexate in particular that we should pause treatment either before or after the vaccine,” Dr Al-Janabi concluded.

Reference
  1. Al-Janabi A. Antibody responses to SARS-CoV-2 vaccination in patients receiving immunomodulators for immune-mediated inflammatory disease. FC-17, Psoriasis from Gene to Clinic 2021, 9–11 December.