PT  - JOURNAL ARTICLE
AU  - Peter Mandl
AU  - Selma Tobudic
AU  - Helmut Haslacher
AU  - Thomas Karonitsch
AU  - Daniel Mrak
AU  - Thomas Nothnagl
AU  - Thomas Perkmann
AU  - Helga Radner
AU  - Judith Sautner
AU  - Elisabeth Simader
AU  - Florian Winkler
AU  - Heinz Burgmann
AU  - Daniel Aletaha
AU  - Stefan Winkler
AU  - Stephan Blüml
TI  - Response to SARS-CoV-2 vaccination in systemic autoimmune rheumatic disease depends on immunosuppressive regimen: a matched, prospective cohort study
AID  - 10.1136/annrheumdis-2021-221788
DP  - 2022 Jul 01
TA  - Annals of the Rheumatic Diseases
PG  - 1017--1022
VI  - 81
IP  - 7
4099  - http://ard.bmj.com/content/81/7/1017.short
4100  - http://ard.bmj.com/content/81/7/1017.full
SO  - Ann Rheum Dis2022 Jul 01; 81
AB  - Objective To assess the humoral response to messenger RNA (mRNA) vaccine of patients with systemic autoimmune rheumatic disease (SARD) and the effect of immunosuppressive medication in a matched cohort study.Methods Patients with SARD were enrolled and matched 1:1 for sex and age with healthy control (HC) subjects. Differences in humoral response to two doses of an mRNA vaccine in terms of seroconversion rate (SCR) and SARS-CoV-2 antibody level between the two groups and the impact of treatment within patients with SARD were assessed.Results We enrolled 82 patients with SARD and 82 matched HC. SCR after the first dose was lower among the patient group than that of HC (65% compared with 100% in HC, p<0.0001) but levelled up after the second dose (94% vs 100%). After the second dose, SCR was lower for patients on combination disease-modifying antirheumatic drug (DMARD) therapy compared with all other groups (81% compared with 95% for monotherapy, p=0.01; 100% for both no DMARD therapy and HC, both p<0.0001). In addition, antibody levels after both doses were lower in patients compared with HC. We found that vaccination response was determined primarily by the number of DMARDs and/or glucocorticoids received, with patients receiving combination therapy (dual and triple therapy) showing the poorest response.Conclusions Patients with SARD showed a good response after the second vaccination with an mRNA vaccine. However, the choice of immunosuppressive medication has a marked effect on both SCR and overall antibody level, and the number of different immunomodulatory therapies determines vaccination response.Data are available upon reasonable request. Unpublished data are available upon reasonable request.