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Medicine Matters rheumatology

August 30, 2022: Findings from a US study demonstrated “substantial improvement” in COVID-19 outcomes over time, which the researchers attributed to vaccination and improvements in diagnosis and treatment. They found that despite receipt of immunosuppressive treatments, “vaccination provided important benefits for many of these patients.”

May 12, 2022: Research from a team in the Netherlands suggested that people on immunomodulatory therapy have similar rates of breakthrough SARS-CoV-2 infection to healthy controls, and that those with prior infection or seroconversion after vaccination have a reduced risk for breakthrough infection.

February 14, 2022: Researchers evaluated the durability of antibody responses to two doses to messenger RNA vaccines in patients with RMDs, finding that the vast majority had titers above the predicted threshold for neutralizing ability after 6 months. An additional study looking at predictors of breakthrough infection risk showed that higher antibody titers at 4–6 weeks postvaccination were associated with reduced risk for COVID-19 approximately 5 months later.

November 30, 2021: A study of patients with RMDs and COVID-19 found that hospitalization rates were significantly lower in fully vaccinated individuals who experienced breakthrough infections than in unvaccinated people. None of the fully or partially vaccinated people in the study died, compared with 4.1% of unvaccinated people, emphasizing the “critical importance of full SARS-CoV-2 vaccination" in this population.

November 3, 2021: An investigation carried out as part of the CoronavRheum trial showed that the Sinovac inactivated SARS-CoV-2 vaccine has "moderate" immunogenicity in people with myopathy following two doses of the vaccine, but the response was "negligible" after the first dose, supporting the need for both doses. Similarly, a study of people with giant cell arteritis found that almost all participants mounted an antibody response to two doses of the Pfizer–BioNTech (BNT162b2) vaccine, compared with less than half following the first dose, leading the authors to conclude that “particular caution is warranted until the completion of the full vaccine schedule.”

A study published in The Lancet Rheumatology evaluated the immunogenicity of a third booster dose of the Pfizer–BioNTech vaccine in 17 people with rheumatoid arthritis who had no or minimal response to the initial two-dose regimen. The researchers found that the booster dose, along with temporary discontinuation of DMARDs, gave rise to antibody responses in all but two of the participants, supporting recommendations for booster doses in certain RMD patients.

September 16, 2021: Findings from two studies published in the Annals of the Rheumatic Diseases point to low overall rates of breakthrough COVID-19 following vaccination. Additionally, the results of a small study, also published in the Annals of the Rheumatic Diseases, suggest that having a booster vaccine dose may augment the humoral immune response to vaccination, supporting recent recommendations for booster doses in the USA and other settings.

September 8, 2021: A meta-analysis published in Autoimmunity Reviews synthesized data from a total of 25 studies evaluating the immune response to mRNA SARS-CoV-2 vaccines in people with immune-mediated inflammatory diseases (IMIDs). The researchers report that most people with IMIDs achieve seroconversion following two doses, but seroconversion rates were significantly lower in these people relative to healthy controls. They also found that people with rheumatoid arthritis had lower seroconversion rates than those with other diseases, and rituximab or abatacept treatment was associated with an impaired antibody response.

August 17, 2021: Research published in in Arthritis & Rheumatology by Peter Izmirly (New York University Grossman School of Medicine, USA) and co-authors evaluated COVID-19 vaccine effectiveness in a cohort of 90 people with systemic lupus erythematosus. The team found that these patients, particularly those on immunosuppressants, had a reduced antibody response to the vaccines relative to healthy controls.

August 11, 2021: Findings from two studies provide further support for the importance of having both vaccine doses. Laura Boekel (Amsterdam Rheumatology and Immunology Center, the Netherlands) and team report in The Lancet Rheumatology that seroconversion rates in people with immune-mediated diseases were higher after the second versus the first dose of any of the four available SARS-CoV-2 vaccines. Additionally, a study by Maria Prendecki and team published in the Annals of the Rheumatic Diseases found that individuals with prior SARS-CoV-2 infection have robust antibody responses to vaccination, suggesting that booster strategies may warrant investigation.

August 2, 2021: A phase 4 trial published in Nature Medicine showed that people with RMDs have a "reduced but acceptable" antibody response to two doses of the Sinovac (CoronaVac) inactivated SARS-CoV-2 vaccine. An exploratory multivariate analysis suggested that older age (≥60 years) and use of prednisone, methotrexate, mycophenolate mofetil, tumor necrosis factor (TNF) inhibitors, abatacept, or rituximab, were significantly associated with a reduced likelihood of an antibody response.

June 25, 2021: Study findings from Andrea Rubbert-Roth (Kantonsspital St Gallen, Switzerland) and colleagues showed that RA patients are significantly more likely than healthy controls to require both doses of the Pfizer–BioNTech (BNT162b2) or Moderna (mRNA-1273) vaccine in order to mount an adequate immune response. The researchers say that their study, published as a comment in The Lancet Rheumatology, emphasizes the importance of the second dose for people with RA.

June 23, 2021: A study of 264 RMD patients with stable disease found that the vast majority developed a "significant humoral response" following both doses of the Pfizer–BioNTech (BNT162b2) vaccine despite continued immunomodulatory treatment. Yolanda Braun-Moscovici (Rambam Health Care Campus, Haifa, Israel) and colleagues conclude in the Annals of the Rheumatic Diseases that their findings "provide reassurance to patients with [RMDs] treated with immunomodulatory agents and their physicians."

June 8, 2021: Study findings presented at the EULAR 2021 Virtual Congress indicated that the Pfizer–BioNTech (BNT162b2) vaccine is immunogenic in most RMD patients. Victoria Furer (Tel Aviv Sourasky Medical Center, Israel) reported an 86% seropositivity rate among 686 patients with RMDs, compared with 100% among 121 healthy controls.

May 26, 2021: A case series published in the Annals of Internal Medicine described the clinical characteristics of 20 patients with RMDs who did not have detectable antibodies against the SARS-CoV-2 spike protein 1 month after receiving their second dose of the Pfizer–BioNTech (BNT162b2) or Moderna (mRNA-1273) vaccine. The most common RMD diagnosis in this group of nonresponders was systemic lupus erythematosus (50%), rituximab was the most frequently prescribed biologic (55%), and mycophenolate mofetil was the most commonly used conventional DMARD (50%).

May 11, 2021: Research by Georg Schett (Friedrich-Alexander University Erlangen-Nuremberg, Germany) and team showed that humoral immune responses to the Pfizer–BioNTech (BNT162b2) vaccine may be "delayed and reduced" among RMD patients relative to healthy controls. However, the study authors found that vaccination "essentially works" in this patient population, supporting current recommendations.

March 31, 2021: The study by Hoyer and colleagues found that the Pfizer–BioNTech (BNT162b2) and Moderna (mRNA-1273) vaccines elicited an appropriate immune response in patients with RMDs, albeit with significantly lower antibody levels among the 26 patients with chronic inflammatory diseases relative to 42 healthy controls 1 week after the second vaccine dose. The researchers conclude that further studies are needed to establish antibody titer persistence in immunosuppressed individuals, and suggest that booster doses may be needed. Additional study results by Dorry Segev and colleagues from Johns Hopkins University in Baltimore, Maryland, USA, demonstrated that almost three-quarters of 123 RMD patients developed detectable antibody response following the first dose of an mRNA vaccine against COVID-19, but certain treatment regimens, including rituximab and mycophenolate, may compromise the vaccine response.