Patients with systemic lupus erythematosus (SLE) show reduced antibody responses after vaccination with COVID-19, likely due to anti-symptomatic agents such as belimumab (Benlysta) and mycophenolate mofetil (MMF). researchers said.
Immunoglobulin G (IgG) titers measured two weeks after the second dose of the mRNA COVID vaccine were 1,887 in It was approximately 20% lower in 342 lupus patients compared to the mean. Baltimore, and colleagues.
The effect was most pronounced in patients taking broad-spectrum immunosuppressants such as MMF and tacrolimus, who had approximately a 30% reduction in IgG responses compared to healthcare workers, researchers said. reported in Arthritis care and research.
However, retention of MMF for a period of time after vaccination (usually 1 week) decreased, such that post-immunization IgG titers were about 20% lower in patients with drug ‘holidays’ compared to non-SLE groups. Petri and colleagues noted that they did not see an increase in SLE relapse rates during vacation. , explained that “historical data” showed no effect on the efficacy of the COVID vaccine, but feared that withholding tacrolimus would too likely cause an SLE flare.)
They reported that a common treatment for rheumatic disease was reduce the effectiveness of vaccines, although not so much as to render them useless.In fact, earlier this month the American College of Rheumatology (ACR) new guidance Although there are some exceptions, most vaccines can be administered without worrying about a washout period.
However, these guidelines intentionally exclude COVID vaccines as the evidence is still evolving.Ann ACR Guidelines issued last August For COVID vaccinations for patients with rheumatic diseases, we asked for a 1-2 week pause on many medications. These included MMF and other broad-spectrum immunosuppressants, as well as more targeted therapies such as belimumab, rituximab (Rituxan), and Janus-activated kinase inhibitors. Hold MMF for at least 10 days It was found best in a study reported at the 2022 ACR Annual Meeting by another Hopkins group.
For the current study, Petri and colleagues analyzed data collected from a specially recruited cohort of lupus patients collected at Hopkins University and from workers at five hospitals in the university’s health care system. All provided serial blood samples over 200 days post-vaccination and were able to analyze SARS-CoV-2 spike protein antibody titers.
About two-thirds of the lupus cohort were not taking immunosuppressants during the study period. The rest were divided equally between those who continued as usual and those who abstained for 1 week after each vaccination.
Although there was considerable inter-individual variability, mean titers for most groups (loop cohort, stratified by immunosuppressants as usual, none, or short vacation) decreased in parallel until about 120 days after the second dose of vaccine, approximately equal to about half of the initial peak by day 200.
However, the 24/7 immunosuppressant group showed only a weak response from the beginning, with a slower decline thereafter and a mean IgG antibody titer at 200 days similar to that of the other groups.
Withholding MMF or other immunosuppressants or continuing them as usual appeared to have no effect on SLE disease activity. and standard assessment trajectories, including physician global assessment, were similar to the number of disease relapses.
One of the surprises of the new data is that despite the expectation that belimumab had no effect on antibody responses, it actually showed some decline in patients taking the drug (belimumab at peak Other patients averaged 2.7 vs 5.7, P.=0.018). Sixty-seven percent of patients taking belimumab had her IgG response, whereas 90% of otherwise treated lupus patients (P.=0.18).
Despite this finding, Petri and colleagues opposed belimumab’s holiday on the basis of the drug’s pharmacodynamics. It’s not long enough for me,” they wrote.
Limitations of this study included that it included only two vaccine doses without a third (or more) booster, and that the efficacy of clinical vaccines on COVID-19 infection or symptoms was not evaluated. Restrictions on Hopkins’ patient and worker populations were also potential restrictions. Furthermore, since essentially all her SLE patients had received some form of treatment, it was impossible to determine the extent to which the disease itself and its treatment contributed to the reduced antibody response.
This research was supported by a grant from the National Institutes of Health.
One of the co-authors reported a relationship with Merck. Other authors have declared no affiliation with commercial entities.
Arthritis care and research
Source reference: Petri M, et al “Effect of systemic lupus and immunosuppressants on COVID vaccination antibody response” Arthritis Care Res 2023; DOI: 10.1002/acr.25094.