RT Journal Article
SR Electronic
T1 Humoral and T-cell responses to SARS-CoV-2 vaccination in patients receiving immunosuppression
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1322
OP 1329
DO 10.1136/annrheumdis-2021-220626
VO 80
IS 10
A1 Prendecki, Maria
A1 Clarke, Candice
A1 Edwards, Helena
A1 McIntyre, Stacey
A1 Mortimer, Paige
A1 Gleeson, Sarah
A1 Martin, Paul
A1 Thomson, Tina
A1 Randell, Paul
A1 Shah, Anand
A1 Singanayagam, Aran
A1 Lightstone, Liz
A1 Cox, Alison
A1 Kelleher, Peter
A1 Willicombe, Michelle
A1 McAdoo, Stephen P
YR 2021
UL http://ard.bmj.com/content/80/10/1322.abstract
AB Objective There is an urgent need to assess the impact of immunosuppressive therapies on the immunogenicity and efficacy of SARS-CoV-2 vaccination.Methods Serological and T-cell ELISpot assays were used to assess the response to first-dose and second-dose SARS-CoV-2 vaccine (with either BNT162b2 mRNA or ChAdOx1 nCoV-19 vaccines) in 140 participants receiving immunosuppression for autoimmune rheumatic and glomerular diseases.Results Following first-dose vaccine, 28.6% (34/119) of infection-naïve participants seroconverted and 26.0% (13/50) had detectable T-cell responses to SARS-CoV-2. Immune responses were augmented by second-dose vaccine, increasing seroconversion and T-cell response rates to 59.3% (54/91) and 82.6% (38/46), respectively. B-cell depletion at the time of vaccination was associated with failure to seroconvert, and tacrolimus therapy was associated with diminished T-cell responses. Reassuringly, only 8.7% of infection-naïve patients had neither antibody nor T-cell responses detected following second-dose vaccine. In patients with evidence of prior SARS-CoV-2 infection (19/140), all mounted high-titre antibody responses after first-dose vaccine, regardless of immunosuppressive therapy.Conclusion SARS-CoV-2 vaccines are immunogenic in patients receiving immunosuppression, when assessed by a combination of serology and cell-based assays, although the response is impaired compared with healthy individuals. B-cell depletion following rituximab impairs serological responses, but T-cell responses are preserved in this group. We suggest that repeat vaccine doses for serological non-responders should be investigated as means to induce more robust immunological response.Data are available upon reasonable request.