Serological response to SARS-CoV-2 vaccination in patients with inflammatory rheumatic disease treated with disease modifying anti-rheumatic drugs: A cohort study and a meta-analysis - 21/09/22
In patients with IRD, rituximab treatment is associated with the most impaired seroconversion rate after two doses of SARS-Cov-2 vaccine.
The delay between the last injection of rituximab and vaccination seems to be the main factor associated with seroconversion and at least 5-6 months is recommended whenever possible.
Methotrexate, leflunomide and abatacept may have a negative impact on seroconversion rate too.
Vaccination is considered as a cornerstone of the management of COVID-19 pandemic. However, while vaccines provide a robust protection in immunocompetent individuals, the immunogenicity in patients with inflammatory rheumatic diseases (IRD) is not well established.
A monocentric observational study evaluated the immunogenicity of a two-dose regimen vaccine in adult patients with IRD (n=123) treated with targeted or biological therapies. Serum IgG antibody levels against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike proteins were measured after the second vaccination. In addition, a search for observational studies performed in IRD under biologic or targeted therapies up to September 31, 2021 (PROSPERO registration number: CRD42021259410) was undertaken in publication databases, preprint servers, and grey literature sources. Studies that reported sample size, study date, location, and seroprevalence estimate were included. A meta-analysis was conducted to identify demographic differences in the prevalence of SARS-CoV-2 antibodies.
Of 123 patients (median age 66 IQR 57–75), 69.9% have seroconverted after vaccination. Seroconverted patients were older than non-seroconverted ones in our cohort. Rituximab was associated with a significantly low antibody response. Besides, we identified 20 seroprevalence studies in addition to our cohort including 4423 participants in 11 countries. Meta-analysis confirmed a negative impact of rituximab on seroconversion rate and suggested a less substantial effect of abatacept, leflunomide and methotrexate.
Rituximab impairs serological response to SARS-CoV-2 vaccines in patients with IRD. This work suggests also a negative impact of abatacept, methotrexate or leflunomide especially when associated to biological therapy.El texto completo de este artículo está disponible en PDF.
Keywords : COVID-19, Sars-Cov2 vaccination, Seroconversion rate, Inflammatory rheumatic diseases, Immune-mediated diseases, Meta-analysis
Vol 89 - N° 5Artículo 105380- octobre 2022 Regresar al número
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