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High antibody response to two-dose SARS-CoV-2 messenger RNA vaccination in patients with rheumatic and musculoskeletal diseases
  1. Jake A Ruddy1,2,
  2. Caoilfhionn Marie Connolly2,
  3. Brian J Boyarsky1,
  4. William A Werbel3,
  5. Lisa Christopher-Stine2,
  6. Jacqueline Garonzik-Wang1,
  7. Dorry L Segev1,4,
  8. Julie J Paik2
  1. 1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3 Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Dorry L Segev, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; dorry{at}

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SARS-CoV-2 mRNA vaccination elicited high immunogenicity in immunocompetent people in the original vaccine trials,1 2 though recent studies have shown blunted immunogenicity in patients with rheumatic and musculoskeletal diseases (RMDs) after a single dose and case reports of non-response after two doses.3 4 We previously detailed antibody response in patients with RMD following the first dose of SARS-CoV-2 mRNA vaccination and herein report response and factors associated with response to two-dose vaccination in a larger cohort.

As previously reported,3 patients aged ≥18 years old with RMD were recruited to participate in this prospective, observational cohort via social media outreach to national RMD organisations between 12 July 2020 and 16 March 2021. Demographics, diagnoses and therapeutic regimens were collected via participant report through the Research Electronic Data Capture tool. One month after dose 2 (D2), participants underwent SARS-CoV-2 antibody testing on the semiquantitative Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay, which measures total antibody (IgM and IgG) to the SARS-CoV-2 S receptor-binding domain (RBD) protein,5 the target of the mRNA vaccines. Results range from <0.4 to >250 U/mL with a positive response defined as >0.79 U/mL. Associations were evaluated using Fisher’s exact and Wilcoxon rank-sum tests. Participants provided informed consent.

We studied 404 participants who received two doses of the SARS-CoV-2 mRNA vaccine (online supplemental table 1). The median (IQR) age was 44 (36–57), 96% were female, 9% were non-white, …

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  • DLS and JJP are joint senior authors.

  • Handling editor Josef S Smolen

  • Twitter @CaoilfhionnMD

  • JAR and CMC contributed equally.

  • Contributors All authors contributed to study design. JAR and BJB contributed to data collection. All authors contributed to data analysis and interpretation. All authors contributed to drafting of the manuscript.

  • Funding This research was made possible with generous support of the Ben-Dov family. This work was supported by grant number F32DK124941 (Boyarsky), and K23DK115908 (Garonzik‐Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), K24AI144954 (Segev) from National Institute of Allergy and Infectious Diseases (NIAID), K23AR073927 (Paik) from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAIM).

  • Disclaimer The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organisations imply endorsement by the US Government.

  • Competing interests DLS has the following financial disclosures: consulting and speaking honoraria from Sanofi, Novartis, CSL Behring, Jazz Pharmaceuticals, Veloxis, Mallincrodt and Thermo Fisher Scientific. LC-S has the following financial disclosures: consultant fees from Janssen, Boehringer-Ingelheim, Mallinckrodt, EMD-Serono, Allogene and ArgenX.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.