medwireNews: People with immune-mediated inflammatory diseases (IMIDs), particularly those on rituximab or abatacept, may have a reduced antibody response to messenger (m)RNA SARS-CoV-2 vaccines relative to the general population, show findings from a systematic review and meta-analysis.
Vishal Sharma (Postgraduate Institute of Medical Education and Research, Chandigarh, India) and co-authors evaluated data from a total of 25 studies, finding that the pooled seroconversion rate following both vaccine doses in people with IMIDs was 83.1%. People with IMIDs were significantly less likely to achieve seroconversion than healthy controls, at an odds ratio of 0.05.
When participants were categorized according to diagnosis, those with spondyloarthritis, inflammatory bowel disease, or systemic lupus erythematosus had higher rates of seroconversion than those with rheumatoid arthritis or vasculitis, at 95.6%, 95.2%, and 90.7% versus 79.5% and 70.5%, respectively.
“It is unclear whether this is attributable to the underlying disease or to the differences in therapies for these diseases,” remark Sharma et al.
They say that pooled seroconversion rates were “excellent” (>90%) in people taking tumor necrosis factor (TNF) inhibitors, interleukin inhibitors, and anti-integrin therapies, but “slightly lower” (70–90%) with other drugs including mycophenolate mofetil, methotrexate, hydroxychloroquine, and Janus kinase (JAK) inhibitors.
However, they report that seroconversion rates were “much lower” in people taking anti-CD20 antibodies such as rituximab (39.0%) or the anti-CTLA-4 therapy abatacept.
These findings “make a strong case for assessing seroconversion in patients who are on anti-CD20 or anti-CTLA-4 therapies,” but “do not indicate the need [to] assess antibody responses in patients on TNF inhibitors, anti-integrins or [JAK] inhibitors,” write the researchers in Autoimmunity Reviews.
They note that people on TNF inhibitor monotherapy were significantly more likely to achieve seroconversion than those on combination therapy with a TNF inhibitor plus methotrexate or thiopurines.
The team also observed that pooled seroconversion rates in people with IMID were lower after a single vaccine dose than after the second dose (69.3 vs 83.1%), which “highlights the importance of a two-dose mRNA vaccine regimen.”
While this study provided estimates of antibody responses following vaccination, Sharma and colleagues caution that the impact on breakthrough SARS-CoV-2 infection “is uncertain,” with “sparse data on T cell responses following SARS-CoV-2 infection in patients with IMIDs,” highlighting the need for more research.
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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