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Booster-dose SARS-CoV-2 vaccination in patients with autoimmune disease: a case series
  1. Caoilfhionn M Connolly1,
  2. Mayan Teles2,
  3. Sarah Frey2,
  4. Brian J Boyarsky2,
  5. Jennifer L Alejo2,
  6. William A Werbel3,
  7. Jemima Albayda1,
  8. Lisa Christopher-Stine1,
  9. Jacqueline Garonzik-Wang2,
  10. Dorry L Segev2,4,
  11. Julie J Paik1
  1. 1 Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Surgery, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3 Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4 Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Dorry L Segev, Surgery, Johns Hopkins, Baltimore, Maryland, USA; dorry{at}

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An attenuated humoral response to SARS-CoV-2 vaccination has been observed in some patients with autoimmune disease,1 2 and immunosuppressed status has been associated with an increased risk of COVID-19 infection despite vaccination.3 Recent studies have demonstrated enhanced humoral response to third-dose SARS-CoV-2 vaccination in immunosuppressed transplant patients,4 5 but the immunogenicity of booster vaccination in other immunosuppressed populations is unknown. Thus, we sought to describe the humoral response in patients with autoimmune disease who received a booster SARS-CoV-2 vaccine.

Using our prospective cohort of patients with autoimmune disease,5 we included patients who reported receipt of a single booster dose of SARS-CoV-2 mRNA or adenovirus vector vaccine between 10 April and 11 June 2021. We observed serial anti-spike antibody responses among these participants.

A total of 18 participants received a booster SARS-CoV-2 vaccine dose (table 1). Most (13/18) were women with median (IQR) age of 55 (44–63) years. The most common autoimmune diagnoses included myositis (n=6) and inflammatory arthritis (n=3). Most (14/18) were on antimetabolite therapy; mycophenolate was the most commonly reported immunosuppressive therapy (n=8), with a median (IQR) daily dose of 3000 mg (2500–3000 mg). Participants completed initial vaccination with either Pfizer (n=8), Moderna (n=6) or Johnson & Johnson/Janssen (J&J) Ad26.COV2.S (n=4).

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Table 1

Vaccines administered, autoimmune diagnoses, immunosuppression and peri-vaccination management with longitudinal anti-spike antibody responses

Anti-spike antibodies, evaluated via Roche Elecsys anti-RBD pan-Ig were negative in 10 participants (anti-RBD <0.8 U/mL) and low-positive (anti-RBD …

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  • Handling editor Josef S Smolen

  • Twitter @CaoilfhionnMD, @JenLAlejo

  • Contributors CMC, MT, SF, BJB, JLA, JA, LC-S, WAW, JG-W, DLS, JJP substantially contributed to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work. CMC, MT, SF, BJB, JLA, JA, LC-S, WAW, JG-W, DLS, JJP contributed to drafting the work or revising it critically for important intellectual content. CMC, MT, SF, BJB, JLA, JA, LC-S, WAW, JG-W, DLS, JJP contributed to final approval of the version to be published. CMC, BJB, JLA, DLS, JJP contributed to agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by grant number F32DK124941 (Boyarsky), 5T32DK007713 (Alejo) 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, 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.