Authors (including presenting author) :
So H(1)(2), Li T(1), Chan V(1), Tam L-S(1)(2), Chan PKS(3)
Affiliation :
(1) Department of Medicine & Therapeutics, Prince of Wales Hospital, (2)Department of Medicine & Therapeutics, The Chinese University of Hong Kong, (3) 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, the efficacy and safety of COVID-19 vaccines in patients with autoimmune rheumatic diseases (ARD) is uncertain due to a complex interplay of underlying autoimmunity and immunosuppressive therapies used. Systemic lupus erythematosus (SLE) is the prototypic ARD characterized by systemic inflammation, requiring treatment with immunosuppressive medications and leading to multiple medical comorbidities. There are concerns regarding increased side effects, risk of inducing disease flare and reduced efficacy of these vaccines in SLE patients due to the underlying autoimmunity as well as immunosuppressive medication use.
Objectives :
This study was to investigate the immunogenicity and safety of both inactivated and mRNA COVID-19 vaccines in patients with SLE.
Methodology :
This was a prospective, single-centre, case-control study. Patients with SLE planning to receive COVID-19 vaccines were recruited and matched 1:1 with healthy controls. The immunogenicity of the COVID-19 vaccines was assessed by a surrogate neutralization assay at 28 days after the second dose. The main outcomes included the antibody response and adverse effects comparing SLE patients and controls. Predictors of responses in SLE patients were analyzed. The change of SLE disease activity was evaluated.
Result & Outcome :
Sixty-five SLE patients received 2 doses of COVID-19 vaccines (Comirnaty: 38; CoronaVac: 27) were recruited. Many of them were on systemic glucocorticoids (75.8%) and immunosuppressants (54.5%). At day 28 after the second dose of vaccines, 92.3% (Comirnaty: 100%; CoronaVac: 81.5%, p=0.01) had positive neutralizing antibody. However, compared to the age, gender, vaccine type matched controls, the level of neutralizing antibody was significantly lower (p< 0.001) in patients with SLE . The self-reported side effects of the vaccines in lupus patients were common but mild, and were more frequent in the Comirnaty group. There was no significant change in lupus disease activity up to 28 days after vaccination. The independent predictors of neutralizing antibody level included the dosage of systemic glucocorticoids, use of mycophenolate and type of vaccines.
To conclude, COVID-19 vaccines produced satisfactory but impaired serological response in SLE patients compared to controls which was dependent on the immunosuppressive medications use and type of vaccines received. There was no new short-term safety signal noted. Booster-dose COVID-19 vaccination is encouraged.
