COVID-19 vaccine response evaluated in people with lupus
medwireNews: The antibody response to COVID-19 vaccination may be compromised in people with systemic lupus erythematosus (SLE), particularly those on immunosuppressive therapy, researchers report.
Peter Izmirly (New York University Grossman School of Medicine, USA) and co-authors evaluated antibody responses in 90 patients with SLE from the New York University Lupus Cohort and 20 healthy controls who had received a complete course of an approved COVID-19 vaccine. A total of 79% of people with SLE were taking hydroxychloroquine, while 29% were receiving systemic glucocorticoids and 42% at least one immunosuppressant.
As reported in Arthritis & Rheumatology, people with SLE had significantly lower median levels of immunoglobulin G antibodies against the SARS-CoV-2 spike protein at approximately 2 weeks after the final vaccine dose compared with controls, at 235.2 versus 435.7 units/mL.
Moreover, post-vaccine levels of these antibodies in the SLE cohort fell below the lowest level seen in the control group (100 units/mL) in 28.8% of patients, and these individuals were categorized as having a low antibody response.
Logistic regression analysis identified four independent predictors of low antibody response, namely being on any immunosuppressant other than antimalarials (odds ratio [OR]=15.14), having normal levels of anti-double stranded (ds)DNA antibodies prior to vaccination (OR=14.50), low platelet values (OR=1.55 per each decrease of 50x109 cells/L), and normal complement C3 levels (OR=4.95 versus low levels).
“While minimal protective antibody levels remain unknown, these results, supported by other studies, raise concerns for our lupus patients, many of whom rely on medications to maintain low disease activity,” write Izmirly and team.
The researchers say that “[t]he finding of anti-dsDNA antibodies positively correlating with higher responses to COVID-19 vaccination was initially unexpected,” noting that the association persisted when controlling for medication use.
They suggest “[i]t could be hypothesized that the presence of anti-dsDNA antibodies is a proxy of elevated type I interferon activity in these patients,” a protein that has “potential to enhance antibody responses to foreign antigens.”
The study authors also investigated SLE flare risk following COVID-19 vaccination, finding that flares were “rare,” experienced by 11.4% of the cohort. All but one of the flares were considered to be mild or moderate.
“These data are reassuring and support that vaccines do not exacerbate disease activity, a finding which should alleviate vaccine hesitancy,” they write.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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