Artikel
Comparison of disease-modifying anti-rheumatic drugs in inducing immunogenicity to SARS-CoV2 vaccines in adult patients with autoimmune musculoskeletal inflammatory rheumatic diseases
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Veröffentlicht: | 31. August 2022 |
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Introduction: The interplay between humoral and cellular response after vaccination against COVID-19 infection in patients with autoimmune inflammatory rheumatic diseases (AIRD) remains unknown. We investigated the impact of 4 different immunosuppressive therapies in AIRD patients under stable low disease activity status on the development of humoral and cellular immune responses to full 2-dose SARS-CoV-2 vaccination.
Methods: Patients with rheumatoid arthritis, axial spondyloarthritis or psoriasis arthritis treated with tumor necrosis factor inhibitors (TNFi), interleukin (IL)-17i (biologics-), janus kinase inhibitors (JAKi) (targeted synthetic-), or methotrexate (MTX) (conventional synthetic- disease modifying antirheumatic drugs (csDMARD)) alone or in combination were included. Almost all patients received mRNA-based vaccine, 4 patients had a heterologous scheme. Neutralizing capacity (NC) against SARS-CoV-2 wild variant and levels of IgG against SARS-CoV-2 spike-protein were evaluated together with quantification of activation markers on T-cells and their production of key cytokines 4 weeks after first and second vaccination.
Results: Overall, a total of 92 patients were included in the final study cohort with the median age of 50 years [IRQ: 39-56] and a 50% female ratio. 33.7% patients were on TNFi, 26.1% on IL-17i, 26.1% on JAKi, each group encompassing patients receiving drug inhibitors alone or in combination with MTX. 14.1% were treated with MTX alone. Although after first vaccination only 37.8% patients presented neutralizing antibodies, the majority (94.5%) showed neutralizing antibodies after second vaccination. Spike-protein specific IgG antibodies were found in 98.9% of all patients. Patients on IL17i developed the highest titers compared to the other modes of action. Co-administration of MTX led to lower titers compared to b/tsDMARD monotherapy. NC correlated well with IgG against SARS-CoV-2 spike-protein titers. T-cell immunity revealed similar frequencies of activated T-cells and cytokine profiles across therapies.
Conclusion: Even after insufficient seroconversion for NC and IgG against SARS-CoV-2 spike-proteins in AIRD patients between different modes of action, a second vaccination covered almost all patients regardless of DMARDs therapy, with better outcomes in those on IL-17i. However, no difference of b-/ts- or cs-DMARD therapy was found on the cellular immune response.