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Successful BNT162b2 booster vaccinations in a patient with rheumatoid arthritis and initially negative antibody response
  1. Fredrik N Albach,
  2. Gerd R Burmester,
  3. Robert Biesen
  1. Department of Rheumatology and Clinical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Robert Biesen, Department of Rheumatology and Clinical Immunology, Charite Universitatsmedizin Berlin, Berlin, Germany; robert.biesen{at}

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The COVID-19 pandemic poses unique challenges regarding the optimal care of patients with rheumatic diseases, who may have an increased risk of infection and hospitalisation. It is therefore highly important to ensure successful vaccination of these patients.1 The messenger RNA vaccine BNT162b2 (Comirnaty by BioNTech/Pfizer) against SARS-CoV-2 strongly reduces infection, transmission, hospitalisation and death in immunocompetent patients. The development of neutralising antibodies after vaccination has been associated with protection from COVID-19.2 However, a decreased immunogenicity of several vaccines has been described under immunosuppressive medication,3 and first reports seem to confirm reduced antibody responses after vaccinations against SARS-CoV-2 in patients on some immunosuppressive medications (e.g. in one preprint rituximab, glucocorticoids and possibly JAK inhibitors).4 This led rheumatologists to address the question of how to deal with patients who show insufficient immunogenicity after vaccination.

In this letter, we describe a case with an initially negative antibody response and seroconversion after repeated booster vaccinations without interruption of immunosuppressive medication. The patient is a 54-year-old man, …

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  • Handling editor Josef S Smolen

  • Contributors All authors contributed to acquisition, analysis and interpretation of the data and drafting the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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