RT Journal Article
SR Electronic
T1 Effectiveness of SARS-CoV-2 vaccination in patients with rheumatoid arthritis (RA) on DMARDs: as determined by antibody and T cell responses
JF RMD Open
JO RMD Open
FD EULAR
SP e002050
DO 10.1136/rmdopen-2021-002050
VO 8
IS 1
A1 Benazir Saleem
A1 Rebecca L Ross
A1 Lesley-Anne Bissell
A1 Aamir Aslam
A1 Kulveer Mankia
A1 Laurence Duquenne
A1 Diane Corsadden
A1 Clive Carter
A1 Pam Hughes
A1 Fatima A Nadat
A1 Panji Mulipa
A1 Mark Lobb
A1 Brendan Clarke
A1 Katie Mbara
A1 Ruth Morton
A1 Sophie Dibb
A1 Rahaymin Chowdhury
A1 Darren Newton
A1 Alexandra Pike
A1 Vishal Kakkar
A1 Sinisia Savic
A1 Francesco DelGaldo
A1 Paul Emery
YR 2022
UL http://rmdopen.bmj.com/content/8/1/e002050.abstract
AB Objectives To assess antibody and T cell responses to SARS-CoV-2 vaccination in patients with rheumatoid arthritis (RA) on disease-modifying antirheumatic drugs (DMARDs).Methods This prospective study recruited 100 patients with RA on a variety of DMARDs for antibody and T cell analysis, pre-vaccination and 4 weeks post-vaccination. Positive antibody response was defined as sera IgG binding to ≥1 antigen. Those that remained seronegative after first vaccination were retested 4 weeks after second vaccination; and if still seronegative after vaccination three. A T cell response was defined an ELISpot count of ≥7 interferon (IFN)γ-positive cells when exposed to spike antigens. Type I IFN activity was determined using the luminex multiplex assay IFN score.Results After vaccine one, in patients without prior SARS-CoV-2 exposure, 37/83 (45%) developed vaccine-specific antibody responses, 44/83 (53%) vaccine-specific T cell responses and 64/83 (77%) developed either antibody or T cell responses. Reduced seroconversion was seen with abatacept, rituximab (RTX) and those on concomitant methotrexate (MTX) compared to 100% for healthy controls (p<0.001). Better seroconversion occurred with anti-tumour necrosis factor (TNF) versus RTX (p=0.012) and with age ≤50 (p=0.012). Pre-vaccine SARS-CoV-2 exposure was associated with higher quantitative seroconversion (≥3 antibodies) (p<0.001). In the subgroup of non-seroconverters, a second vaccination produced seroconversion in 54% (19/35), and after a third in 20% (2/10). IFN score analysis showed no change post-vaccine.Conclusion Patients with RA on DMARDs have reduced vaccine responses, particularly on certain DMARDs, with improvement on subsequent vaccinations but with approximately 10% still seronegative after three doses.