Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: Systematic review and meta-analysis

Highlights

• Immune mediated inflammatory diseases (IMIDs) require immune-modulating therapies which impair responses to vaccination.

• Seroconversion rates after SARS-CoV-2 vaccination are lower in IMIDs as compared to healthy controls

• A two-dose regimen of mRNA vaccine is associated with a better seroconversion rate in IMIDs

• Certain classes of drugs (anti-CD20, anti-CTLA-4) are associated with a poor seroconversion rate

• Assessment of seroconversion may be necessary in patients on some classes of immune modulating therapies.

• Vaccination schedules for patients need to be individualized depending on underlying IMID and current treatment.

Abstract

Objectives

The treatment for COVID-19 often utilizes immune-modulating drugs. These drugs are also used in immune mediated inflammatory diseases (IMIDs). We performed a systematic review about seroconversion after SARS-CoV-2 vaccination in patients with IMIDs and impact of various drugs on seroconversion rates.

Methods

Electronic databases were searched to identify relevant studies reporting seroconversion rates following SARS-CoV-2 vaccination in IMIDs. We calculated the pooled seroconversion rates after a single or two doses of vaccination, pooled seroconversion rates in patients with specific IMIDs, and rates in patients on various drugs/drug classes.

Results

Twenty-five studies were included in the systematic review. The pooled seroconversion rates after two doses of mRNA vaccination were higher (83.1, 95%CI: 74.9–89.0, I² = 90%) as compared to a single dose (69.3, 52.4–82.3, I² = 95%). The odds of seroconversion were lower in IMIDs as compared to healthy controls (0.05, 0.02–0.13, I² = 21%). The seroconversion rates in patients with inflammatory bowel disease (95.2, 95%CI: 92.6–96.9, I² = 0%), spondyloarthropathy (95.6, 95% CI: 83.4–98.9, I² = 35%), and systemic lupus erythematosus (90.7, 95%CI: 85.4–94.2, I² = 0%) were higher as compared to rheumatoid arthritis (79.5, 95% CI: 65.1–88.9, I² = 85%), and vasculitis (70.5, 95% CI: 52.9–83.5, I² = 51%). The seroconversion rates following double dose of mRNA were excellent (>90%) in those on anti-tumour necrosis factor (TNF), anti-integrin (vedolizumab), anti-IL 17 (secukinumab), anti-IL6 (Tocilizumab) and anti-IL12/23 (Ustekinumab) therapies but attenuated (<70%) in patients on anti-CD20 (Rituximab) or anti-cytotoxic T lymphocyte associated antigen (CTLA-4) therapies (Abatacept). The seroconversion rates were good (70–90%) with steroids, hydroxychloroquine, JAK inhibitors, mycophenolate mofetil and leflunomide. Combination of anti-TNF with immunomodulators (azathioprine, 6-meracptopurine, methotrexate) resulted in an attenuated vaccine response as compared to anti-TNF monotherapy.

Conclusion

Seroconversion rates after SARS-CoV-2 vaccination are lower in patients with IMIDs. Certain therapies (anti-TNF, anti-integrin, anti-IL 17, anti-IL6, anti-12/23) do not impact seroconversion rates while others (anti-CD20, anti-CTLA-4) result in poorer responses.