Disease activity and humoral response in patients with inflammatory rheumatic diseases after two doses of the Pfizer mRNA vaccine against SARS-CoV-2

Abstract

Background: The registration trials of messenger RNA (mRNA) vaccines against SARS-CoV-2 did not address patients with inflammatory rheumatic diseases (IRD).

Objective: To assess the humoral response after two doses of mRNA vaccine against SARS-CoV-2, in patients with IRD treated with immunomodulating drugs and the impact on IRD activity.

Methods: Consecutive patients treated at the rheumatology institute, who received their first SARS-CoV-2 (Pfizer) vaccine, were recruited to the study, at their routine visit. They were reassessed 4-6 weeks after receiving the second dose of vaccine, and blood samples were obtained for serology. IRD activity assessment and the vaccine side effects were documented during both visits. IgG antibodies (Abs) against SARS-CoV-2 were detected using the SARS-CoV-2 IgG II Quant (Abbott) assay.

Results: Two hundred and sixty-four patients with stable disease, (mean(SD) age 57.6 (13.18) years, disease duration 11.06 (7.42) years), were recruited. The immunomodulatory therapy was not modified before or after the vaccination. After the second vaccination, 227 patients (86%) mounted IgG Ab against SARS-CoV-2 (mean (SD) 5830.8 (8937) AU/mL) and 37 patients (14%) did not, 22/37 were treated with B cell-depleting agents. The reported side effects of the vaccine were minor. The rheumatic disease remained stable in all patients.

Conclusions: The vast majority of patients with IRD developed a significant humoral response following the administration of the second dose of the Pfizer mRNA vaccine against SARS-CoV-2 virus. Only minor side effects were reported and no apparent impact on IRD activity was noted.

Keywords: COVID-19; antirheumatic agents; autoimmune diseases; biological therapy; vaccination.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 2

Serology per age, classification by disease Scatter plots of antibody titre level by age. Spearman rank correlation coefficient corresponds to −0.24. Colours represent different disease groups: inflammatory joint disease, connective tissue disease, vasculitis and other diseases. CTD, connective tissue diseases.

Figure 1

(A) Antibody titres for the different treatments presented as violin plots with included boxplots. The violin illustrates the kernel probability density of antibody titres, and the boxplot indicates the median and quartiles with whiskers up to 1.5 times the IQR. (B) Violin plots of antibody titres for the different treatments in vaccinated and COVID-19 recovered patients. Mean antibody titres±SE per treatment group. **p-value