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06-09-2021 | COVID-19 | News

Glucocorticoids, B-cell depleting therapies may dampen immune response to COVID-19 vaccines

Author: Claire Barnard


medwireNews: Most people with inflammatory diseases treated with immunomodulatory therapies mount an antibody response to mRNA vaccines against SARS-CoV-2, but the response may be blunted in those taking glucocorticoids or B cell-depleting therapies (BCDT), shows the COVaRiPAD study.

These findings provide “justification for current recommendations for this population to be vaccinated,” write Alfred Kim (Washington University School of Medicine, St Louis, Missouri, USA) and fellow researchers in the Annals of Internal Medicine.

The team analyzed antibody responses in 133 people with immune-mediated inflammatory diseases (IMIDs) – most commonly inflammatory bowel disease (31.6%), rheumatoid arthritis (28.6%), or spondyloarthritis (15.0%) – and 53 immunocompetent controls who received both doses of the Pfizer–BioNTech (BNT162b2) or Moderna (mRNA-1273) vaccine between December 2020 and March 2021.

In all, 88.7% of people with IMIDs and 100% of controls produced anti–SARS-CoV-2 spike (S) immunoglobulin (Ig)G antibodies within 20 days of receiving their second vaccine dose. Antibody levels were lower in the IMID versus the control group, with geometric mean titers at half maximal dilution of 1737 and 5542 units, respectively.

Among people with IMIDs, rates of anti-S IgG seropositivity were lower in the 17 individuals treated with prednisone compared with those not taking the drug (65 vs 92%), as were the geometric mean titers (357 vs 2190 units).

Similarly, Kim et al say that “immunogenicity seemed substantially lower” in the 10 patients using BCDT (rituximab or ocrelizumab), with geometric mean titers of 152 units compared with 2117 units in those not taking these drugs.

“In the BCDT-treated patients, the absence of seroconversion was seen primarily in those with recent administration of therapy,” remark the researchers.

They also evaluated vaccine immunogenicity in people treated with Janus kinase inhibitors, biologics, or antimetabolites such as methotrexate and azathioprine, but were unable to draw conclusions because confidence intervals around the estimates “were wide and overlapped with estimates among participants not using these therapies.”

Kim and colleagues note that their study was carried out before the American College of Rheumatology released recommendations to hold certain immunosuppressant therapies for 1 week either side of vaccination in people with well-controlled disease, and only three participants had held their doses, all of whom were on methotrexate.

The study authors also caution that use of specific therapies is “highly associated” with having an IMID, and therefore “it is difficult to disentangle whether the underlying disease or individual immunosuppressant therapies contribute to diminished vaccine immunogenicity.”

They therefore stress that the “findings should be interpreted with caution and as hypothesis generating.”

The team concludes: “Further studies are needed to determine the importance of contributions of specific medications, exposure to multiple immunosuppressive medications, [IMID] diagnosis, disease state, and additional comorbidities to better understand the critical factors in SARS-CoV-2 vaccine responses.”

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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Ann Intern Med 2021; doi:10.7326/M21-1757