The impact of immunosuppressive therapy on neutralising capacity and anti-RBD-IgG levels in patients with AIRD (n=308) compared with controls (n=296)
| Immunosuppressive therapy*, n | Neutralising capacity (%) | Anti-RBD-IgG (S/CO) | ||||
| Median (IQR) | Unadjusted p value | Adjusted p value | Median (IQR) | Unadjusted p value | Adjusted p value | |
| Immunocompetent controls, n=296 | 96.5 (93.5–97.1) | (ref) | (ref) | 6.7 (6.3–7.1) | (ref) | (ref) |
| AIRD without immunosuppression, n=19 | 95.9 (94.0–96.7) | 0.722 | 0.722 | 6.2 (5.3–6.9) | 0.301 | 0.357 |
| Anti-IL-1 mono, n=3 | 95.3 (45.4–96.6) | 0.381 | – | 6.1 (2.1–6.8) | 0.207 | – |
| Anti-IL-17 mono, n=14 | 96.0 (89.0–96.5) | 0.767 | 0.629 | 6.6 (4.4–6.9) | 0.036 | 0.757 |
| Anti-IL-6 mono, n=14 | 77.3 (55.1–91.8) | 0.001 | 0.073 | 5 (3.9–5.6) | 0.035 | 0.460 |
| Anti-TNFα mono, n=46 | 94.0 (88.2–95.9) | 0.460 | 0.767 | 6.1 (5.1–6.8) | 0.003 | 0.436 |
| Azathioprine+others, n=18 | 95.1 (82.9–96.9) | <0.001 | 0.032 | 6.2 (2.3–7.2) | <0.001 | 0.008 |
| CYC+others, n=5 | 89.2 (48.0–95.4) | 0.083 | 0.221 | 5.5 (2.2–6.3) | 0.040 | 0.154 |
| GC mono, n=9 | 95.5 (93.7–96.3) | 0.717 | 0.563 | 6 (5–7.1) | 0.607 | 0.427 |
| HCQ mono, n=11 | 95.7 (95.3–96.7) | 0.751 | 0.957 | 6.5 (6–7.1) | – | – |
| JAK inhibitors mono, n=21 | 71.1 (52.4–91.2) | <0.001 | 0.006 | 3.2 (2.3–6.3) | <0.001 | 0.006 |
| Leflunomide+others, n=8 | 94.6 (87.1–96.2) | 0.648 | 0.641 | 6.1 (5.7–7) | 0.056 | 0.041 |
| MMF+others, n=10 | 74.9 (32.1–96.6) | <0.001 | 0.002 | 4.6 (0.2–6.2) | <0.001 | 0.004 |
| MTX mono, n=32 | 87.3 (43.1–96.2) | <0.001 | 0.113 | 5.4 (0.5–6.7) | <0.001 | 0.005 |
| MTX+JAKi, n=6 | 77.5 (54.5–95.8) | 0.032 | 0.111 | 4.6 (1.7–5.8) | 0.004 | 0.058 |
| MTX+others, n=25 | 79.2 (61.6–93.5) | <0.001 | 0.081 | 5.4 (1.6–6.7) | <0.001 | 0.006 |
| RTX ≤6 months before vacc., n=23 | 3.7 (0–9.6) | <0.001 | 0.001 | 0 (0–0) | <0.001 | <0.001 |
| RTX >6 months before vacc., n=17 | 20.3 (7.0–74.0) | <0.001 | 0.002 | 0 (0–2.1) | <0.001 | <0.001 |
| Sulfasalazine+others, n=3 | 78.5 (76.9–96.9) | 0.198 | 0.167 | 5.3 (2.8–7.0) | 0.315 | 0.685 |
| Others, n=13 | 93.1 (27.3–96.3) | <0.001 | 0.029 | 5.6 (0.6–6.9) | <0.001 | 0.003 |
| No consistent therapy, n=11 | 94.5 (53.8–96.7) | – | – | 5.9 (2.5–6.6) | – | – |
P values were estimated by a Wald test as combined p value of the two-part model. Statistically significant results in bold. A hyphen indicates that calculation was not possible within the model.
Adjusted multivariable analysis includes the covariates age, sex, BMI, type of vaccination, vaccine interval in days, interval between second vaccination and antibody testing in days, rheumatic diagnosis, comorbidity and immunosuppressive therapy.
*Composition of combination therapy groups is given in online supplemental table 1.
BMI, body mass index; CYC, cyclophosphamide; GC, glucocorticoid; HCQ, hydroxychloroquine; IL, interleukin; JAK, Janus kinase; MMF, mycophenolate; mono, monotherapy; MTX, methotrexate; ref, reference; RTX, rituximab; S/CO, signal/cut-off; TNF, tumour necrosis factor.