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  • SARS-CoV-2 vaccination responses in untreated, conventionally treated and anticytokine-treated patients with immune-mediated inflammatory diseases

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Epidemiology
SARS-CoV-2 vaccination responses in untreated, conventionally treated and anticytokine-treated patients with immune-mediated inflammatory diseases
  1. David Simon1,2,
  2. Koray Tascilar1,2,
  3. Filippo Fagni1,2,
  4. Gerhard Krönke1,2,
  5. Arnd Kleyer1,2,
  6. Christine Meder2,3,
  7. Raja Atreya2,4,
  8. Moritz Leppkes2,4,
  9. Andreas E Kremer2,4,
  10. Andreas Ramming1,2,
  11. Milena L Pachowsky1,2,
  12. Florian Schuch5,
  13. Monika Ronneberger5,
  14. Stefan Kleinert5,
  15. Axel J Hueber1,6,
  16. Karin Manger7,
  17. Bernhard Manger1,2,
  18. Carola Berking2,3,
  19. Michael Sticherling2,3,
  20. Markus F Neurath2,
  21. Georg Schett1,2
  1. 1 Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
  2. 2 Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
  3. 3 Department of Dermatology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
  4. 4 Department of Internal Medicine 1, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
  5. 5 Rheumatology Practice, Erlangen, Germany
  6. 6 Section Rheumatology, Sozialstiftung Bamberg, Bamberg, Germany
  7. 7 Rheumatology Practice Bamberg, Erlangen, Germany
  1. Correspondence to Professor Georg Schett, Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen 91054, Germany; georg.schett{at}uk-erlangen.de

Abstract

Objectives To better understand the factors that influence the humoral immune response to vaccination against SARS-CoV-2 in patients with immune-mediated inflammatory diseases (IMIDs).

Methods Patients and controls from a large COVID-19 study, with (1) no previous history of COVID-19, (2) negative baseline anti-SARS-CoV-2 IgG test and (3) SARS-CoV-2 vaccination at least 10 days before serum collection were measured for anti-SARS-CoV-2 IgG. Demographic, disease-specific and vaccination-specific data were recorded.

Results Vaccination responses from 84 patients with IMID and 182 controls were analysed. While all controls developed anti-SARS-CoV-2 IgG, five patients with IMID failed to develop a response (p=0.003). Moreover, 99.5% of controls but only 90.5% of patients with IMID developed neutralising antibody activity (p=0.0008). Overall responses were delayed and reduced in patients (mean (SD): 6.47 (3.14)) compared with controls (9.36 (1.85); p<0.001). Estimated marginal means (95% CI) adjusted for age, sex and time from first vaccination to sampling were 8.48 (8.12–8.85) for controls and 6.90 (6.45–7.35) for IMIDs. Significantly reduced vaccination responses pertained to untreated, conventionally and anticytokine treated patients with IMID.

Conclusions Immune responses against the SARS-CoV-2 are delayed and reduced in patients with IMID. This effect is based on the disease itself rather than concomitant treatment.

  • vaccination
  • epidemiology
  • COVID-19
  • biological therapy

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Data are under embargo by local authorities if not included into the manuscript.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/annrheumdis-2021-220461

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information. Data are under embargo by local authorities if not included into the manuscript.

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    Footnotes

    • Handling editor Josef S Smolen

    • Twitter @KorayTascilar

    • DS and KT contributed equally.

    • Contributors DS, KT, AK, GK, MN and GS were involved in study design. Sample collection was done by DS, GK, RA, FS, MS, SF, AJH, KM, BM, CB, MS, AK, MN and GS. Experiments and data analysis were performed by DS, KT, FF and KT. DS and KT were responsible for tables and figure. Data interpretation was done by DS, KT, CB, MS, AK, MN and GS. Writing of the manuscript was done by DS, KT, FF, MN and GS. All authors were involved in critical proof reading of the manuscript.

    • Funding The study was supported by the Deutsche Forschungsgemeinschaft (DFG-FOR2886 PANDORA and the CRC1181 Checkpoints for Resolution of Inflammation). Additional funding was received by the Bundesministerium für Bildung und Forschung (BMBF; project MASCARA), the ERC Synergy grant 4D Nanoscope, the IMI funded project RTCure, the Emerging Fields Initiative MIRACLE of the Friedrich-Alexander-Universität Erlangen-Nürnberg, the Schreiber Stiftung and the Else Kröner-Memorial Scholarship (DS, no. 2019_EKMS.27). The present work was performed in (partial) fulfilment of the requirements for obtaining the degree 'Dr rer. biol. hum'. for DS at the Friedrich-Alexander-University Erlangen-Nürnberg (FAU).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.