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Importance of the second SARS-CoV-2 vaccination dose for achieving serological response in patients with rheumatoid arthritis and seronegative spondyloarthritis
  1. Elisabeth Simader1,
  2. Selma Tobudic2,
  3. Peter Mandl1,
  4. Helmuth Haslacher3,
  5. Thomas Perkmann3,
  6. Thomas Nothnagl4,
  7. Judith Sautner4,
  8. Helga Radner1,
  9. Florian Winkler1,2,
  10. Heinz Burgmann2,
  11. Daniel Mrak1,
  12. Daniel Aletaha1,
  13. Stefan Winkler2,
  14. Stephan Blüml1
  1. 1 Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
  2. 2 Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University Vienna, Vienna, Austria
  3. 3 Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
  4. 4 Second Medical Department, Lower Austrian Centre for Rheumatology, Stockerau, Austria
  1. Correspondence to Dr Stephan Blüml, Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna 1090, Austria; stephan.blueml{at}


Objectives To assess the kinetics of humoral response after the first and second dose of messenger RNA (mRNA) vaccines in patients with inflammatory joint diseases compared with healthy controls (HC). To analyse factors influencing the quantity of the immune response.

Methods We enrolled patients with rheumatoid arthritis (RA) and seronegative spondyloarthritis (SpA), excluding those receiving B-cell depleting therapies and assessed the humoral response to mRNA vaccines after the first and the second dose of the vaccine in terms of seroconversion rate and titre. We compared the results to a HC group and analysed the influence of therapies as well as other characteristics on the humoral response.

Results Samples from 53 patients with RA, 46 patients with SpA and 169 healthy participants were analysed. Seroconversion rates after the first immunisation were only 54% in patients with inflammatory arthritis compared with 98% in the HC group. However, seroconversion rates were 100% in all groups after second immunisation. Patients developed reduced antibody titres after the first vaccination compared with HC, but there was no difference after the second dose. While disease modifying anti-rheumatic drug (DMARD) monotherapy did not affect antibody levels, seroconversion rates as well as titre levels were reduced in patients receiving a combination of DMARDs compared with HC.

Conclusions Patients with inflammatory joint diseases under DMARD therapy show impaired humoral responses to the first vaccine dose but excellent final responses to vaccination with mRNA vaccines. Therefore, the full course of two immunisations is necessary for efficient vaccination responses in patients with inflammatory arthritis under DMARD therapy.

  • arthritis
  • COVID-19
  • vaccination

Data availability statement

Data are available upon reasonable request. Not applicable.

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Data availability statement

Data are available upon reasonable request. Not applicable.

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  • Handling editor Gerd-Rüdiger R Burmester

  • ES, ST, SW and SB contributed equally.

  • Contributors ES, ST, HB, SW, JS, DA and SB designed the study. ST, PM, TN, FW, JS, SB, ES, HH, HR and TP analysed the data. ST, PM, ES, HH, TP, JS, HB, DA, SW and SB interpreted the results. ES, ST, PM, DA, JS and SB wrote the paper. All authors revised the manuscript and were involved in editing or quality control. SB had access to all the data, accepts full responsibility for the work and conduct of the study and controlled the decision to publish.

  • 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 PM reports speaker fees from AbbVie, Janssen and Novartis and research grants from AbbVie, BMS, Novartis, Janssen, MSD and UCB. HH received grants from Glock Health, BlueSky Immunotherapies and Neutrolis. JS is the President of the Austrian Society of Rheumatology and Rehabilitation (unpaid position). HB received consulting fees from MSD, Pfizer, Takeda and Gilead, speaker fees from Shionogi, Pfizer and MSD, advisory boards for Valneva, MSD and Gilead. DA reports grants from AbbVie, Amgen, Lilly, Novartis, Roche, SoBi and Sanofi, other from AbbVie, Amgen, Lilly, Merck, Novartis, Pfizer, Roche and Sandoz, outside the submitted work. SB reports personal fees from AbbVie and personal fees from Novartis, outside the submitted work. ES reports support for meeting attendances from Pfizer and Bristol Myers Squibb.

  • 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.