Pfizer–BioNTech vaccine immunogenicity confirmed in patients with AIIRDs
medwireNews: Research confirms immunogenicity with the Pfizer–BioNTech (BNT162b2) COVID-19 vaccine in most patients with autoimmune inflammatory rheumatic diseases (AIIRDs).
The findings, presented in a late-breaking abstract session at the EULAR 2021 Virtual Congress, showed a high seropositivity rate of 86% among 686 patients with an AIIRD, compared with 100% among 121 healthy individuals.
The prospective, observational study collected data from December 2020 to March 2021, during which time “a mass BNT162b2 vaccination campaign launched in Israel with high uptake of vaccination in about 57% of the country’s population,” presenter Victoria Furer, from Tel Aviv Sourasky Medical Center in Israel, explained.
The participants had an average age of 59 years and 69% were women. The predominant AIIRD diagnosis was rheumatoid arthritis, experienced by 38% of patients, followed by psoriatic arthritis and systemic lupus erythematosus in 24% and 15%, respectively. Most (95%) of the patients were taking immunosuppressants, predominantly methotrexate and tumor necrosis factor inhibitors.
Immunogenicity tested 2 to 6 weeks after patients had received the second dose of vaccine showed that patients with AIIRDs had lower serum anti-S1/S2 immunoglobulin G neutralizing antibodies titers than controls, at an average of 133 BAU/mL compared with 219 BAU/mL. But these were still above the cutoff for seropositivity of 15 BAU/mL.
Factors significantly associated with reduced immunogenicity included age over 65 years (average seropositivity rate of 79%); a diagnosis of rheumatoid arthritis (82%), idiopathic inflammatory myopathy (37%), antineutrophil cytoplasmic antibody-associated vasculitis (31%), and other vasculitides (83%); and treatment with glucocorticoids (66%), mycophenolate mofetil (64%), anti-CD20 agents (41%), and abatacept (63% and 40% when combined with methotrexate).
Furer noted that the significantly reduced seropositivity rate of 39% among the 12.7% of patients taking the anti-CD20 antibody rituximab as monotherapy was affected by the prevaccination timing of drug administration. The rate increased from 1% when vaccination was given 90 days after drug administration to 18% when given 180 days after administration and 52% when given 365 days after administration.
She therefore suggested that “postponing treatment with rituximab, when feasible, should be considered to improve immunogenicity.”
Furer also commented that “holding treatment with mycophenolate mofetil and abatacept, especially when combined with methotrexate, may be considered on an individual basis,” but recommended overall that most DMARD treatment “can be continued with relation to the administration of the BNT162b2 mRNA vaccine.”
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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