Immunogenicity and safety of COVID-19 vaccines in patients with inflammatory rheumatic diseases

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Abstract Description
Submission ID :
HAC165
Submission Type
Authors (including presenting author) :
SO H(1), Li T(1), Chan V(1), Tam LS(1), Chan PKS(2)
Affiliation :
(1)Department of Medicine & Therapeutics, The Prince of Wales Hospital, (2)Department of Microbiology, The Chinese University of Hong Kong
Introduction :
Vaccination against SAR-CoV-2 is a new campaign and believed to be the key to end the pandemic. However, there are concerns regarding the efficacy and safety of COVID-19 vaccines in patients with inflammatory rheumatic diseases (IRD) due to a complex interplay of underlying autoimmunity and immunosuppressive therapies required for disease control, which could significantly impair the uptake rate in these vulnerable individuals. The current primary series of vaccination in Hong Kong consists of 3 doses of inactivated (CoronaVac) or mRNA (Comirnaty) vaccines.
Objectives :
To investigate the effects of the third dose of COVID-19 vaccination and their predictors in patients with IRD.
Methodology :
This was a prospective observational study. Patients with IRD planning to receive the third dose of COVID-19 vaccines were recruited. Blood was sampled at baseline and 28 days after the third dose. The immunogenicity of the COVID-19 vaccines was assessed by a surrogate neutralization assay. The main outcomes included the antibody response and adverse effects after vaccination. Predictors of responses were analyzed. The change of disease activity was also evaluated.
Result & Outcome :
A total of 103 patients with IRD (inflammatory arthritis 55%, SLE 43%) were recruited. Many of them were on immunosuppressants (79%) and systemic glucocorticoids (32%). At baseline, which was 176 ± 61 days after the second dose of COVID vaccines, only 57 (55%) had positive neutralizing antibody. More patients received Comirnaty remained sero-positive compared to CoronaVac (82% vs 19%, p< 0.001). At 28 days after the 3rd dose (Comirnaty: 76, CoronaVac: 27), 95.1% of the patients had positive neutralizing antibody. Although the positivity rate was similar between patients received the two different types of vaccines, the antibody level was significant higher in the Comirnaty group (90.7±20.5 vs 69.1±31.4, p< 0.001). Patients on immunosuppressants had significantly lower antibody levels (p=0.003). The self-reported side effects of the vaccines were common but none resulted in hospitalization. Two patients reported flaring up of disease (Comirnaty: 1, CoronaVac: 1) after vaccination.



To conclude, a significant proportion of patients with IRD did not have positive antibody at a mean interval of approximately half a year after the second dose of COVID vaccine. Booster dose gave rise to robust humoral response and no new short-term safety signal was noted. Patients with IRD particularly those on immunosuppressants might have better antibody response after mRNA vaccines.
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