TY - JOUR T1 - Attenuated response to fourth dose SARS-CoV-2 vaccination in patients with autoimmune disease: a case series JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 738 LP - 740 DO - 10.1136/annrheumdis-2021-221641 VL - 81 IS - 5 AU - Mayan Teles AU - Caoilfhionn M Connolly AU - Sarah Frey AU - Teresa Po-Yu Chiang AU - Jennifer J Alejo AU - Brian J Boyarsky AU - Ami A Shah AU - Jemima Albayda AU - Lisa Christopher-Stine AU - William A Werbel AU - Dorry L Segev AU - Julie J Paik Y1 - 2022/05/01 UR - http://ard.bmj.com/content/81/5/738.abstract N2 - Severe, occasionally fatal breakthrough COVID-19 infections despite vaccination have been reported in patients with autoimmune disease,1 bringing vaccine efficacy in this population into question. Recently, the Food and Drug Administration authorised a third vaccine dose in immunocompromised patients who previously received two mRNA vaccines. We previously reported augmented antibody titers in 89% of patients with autoimmune disease after third SARS-CoV-2 vaccination dose2; herein, we describe antibody response in patients who received two additional SARS-CoV-2 vaccine doses after completion of initial series.Patients with autoimmune diseases were recruited for our observational study as previously reported.3 We identified 18 patients ≥18 years of age who completed initial SARS-CoV-2 vaccine series (mRNA or adenovirus vector) and subsequently obtained two additional doses (AD) of SARS-CoV-2 vaccine between 30 April 2021 and 8 July 2021, six of whom were included in a previous report on response after three dose-vaccination.2 Participants with prior COVID-19 infection were excluded. Serial semiquantitative SARS-CoV-2 antibody testing was completed on the Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay, which measures total antibody to the SARS-CoV-2 S-receptor binding domain protein (positive ≥0.8 U/mL) and a consistent correlate of plasma neutralising capacity.4 Participants provided informed consent electronically.Thirteen participants were female, with a median (IQR) age of 56 (52–66) years (table 1). The most common autoimmune diagnoses included inflammatory arthritis (n=4), myositis (n=3) and overlap connective tissue … ER -