Public health

Patients with inflammatory diseases, immunosuppression still mount antibody response to COVID-19 vaccination

COVID-19 vaccines lead to development of antibodies in patients receiving immunosuppressive therapies for chronic inflammatory diseases (CIDs), according to a small study, providing some reassurance for this patient group. Few side effects were seen and the vaccines did not lead to disease flare-ups.

Previous research has found that patients taking more steroids and having high underlying disease activity respond less to immunisations. Also, patients with CID and those taking anticytokine therapies or immunosuppression were generally excluded from the trials testing COVID-19 vaccines. As a result, their efficacy in such patients has not been clear.

Researchers led by Dr Ulf Geisen, of University Medical Center Schleswig-Holstein Campus Kiel in Germany, conducted a single-center study of 26 patients with CID and 42 healthy controls who were all immunised with mRNA vaccines. The results were published in Annals of the Rheumatic Diseases.

Diseases included psoriatic and rheumatoid arthritis, spondyloarthopathy, sarcoidosis, and others, and patients were being treated with various combinations of conventional and biological DMARDs and other therapies. None of the patients had previously had a COVID-19 infection.

Neutralising antibody titres, as assessed by ELISA before vaccination and seven days following the vaccine’s second dose, were observed in all patients in both groups. Levels were lower, however, in the CID patients, at 2,053 binding antibody units/mL compared with 2,685 BAU/mL (p = .037). Both of those levels were above a prespecified cutoff, however.

Side effects from the vaccine were comparable between the groups, though mild systemic side effects including fatigue and myalgia were more frequent in the CID patients. There were no cases of fever in the CID group, compared with 13.5% of the healthy cohort.

Notably, there were no inflammatory arthritis flares associated with either vaccine dose. None of the patients required adjustment to DMARD or glucocorticoid therapy during the six weeks of the trial.

“Our data demonstrate for the first time that patients with a selection of immunosuppressive therapies for CID are able to mount an effective immune response after SARS-CoV-2 mRNA vaccination without significant side effects or flares,” the authors wrote. “Thus, we strongly recommend continued vaccination of immunosuppressed patients.”

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